Telepsychiatry is the delivery of psychiatric services using interactive audio and visual electronic systems between a provider and a
patient that are not in the same physical location. These services may also include electronic prescribing, appointment scheduling,
communication via email or electronic chat, electronic scheduling, and distribution of patient education materials.
The potential benefits of telepsychiatry are:
Reduced wait time to receive psychiatric care.
Avoiding the need to travel to a psychiatrist.
The potential risks of telepsychiatry include, but are not limited to:
There could be some technical problems (video quality, internet connection) that may affect the telepsychiatry session.
ACPC utilizes software that meets the recommended standards to protect the privacy and security of the telepsychiatry sessions.
Alternatives to the use of telepsychiatry:
Traditional facetoface sessions.
I understand that I have the following rights with respect to telepsychiatry:
(1) The laws that protect the confidentiality of my medical information also apply to telepsychiatry. As such, I understand that the information disclosed by me during the course of my treatment isconfidential. However, there are both mandatory and permissive exceptions to confidentiality, including, but not limited to reporting child, elder, and dependent adult abuse; expressed threats of violence towards an ascertainable victim; and where I make my mental or emotional state
an issue in a legal proceeding.
I also understand that the dissemination of any personally identifiable images or information from the telepsychiatry
interaction to researchers or other entities shall not occur without my written consent.
(2) I understand that there are risks and consequences from telepsychiatry, including, but not limited to, the possibility, despite reasonable efforts on the part of my psychiatrist, that: the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by
nauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons.
In addition, I understand that telepsychiatry based services and care may not be as complete as facetoface services. I also understand that if my psychiatrist believes I would be better served by another form of psychiatric services (e.g. faceto face services) I will be referred to a psychiatrist who can provide such services in my area. Finally, I understand that ther
are potential risks and benefits associated with any form of psychiatry
(4) I understand that I have a right to access my medical information and copies of medical records in accordance with Michigan Law, for a $10.00 fee