Clinical Informed Consent Form
Virtual Clinician-Client Service Agreement
Welcome to the GCL Psychological Services Psychometric Virtual Testing. This document contains important information about our live online approach to provide you with the most secure on-screen support, professional services, and business policies. Practitioners conducting virtual testing and telehealth clinical interview are cognizant of the applicability of the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. The United State Capitol Police (USCP) is our direct client. They will receive the findings from this pre-employment evaluation. You will need to speak with them to garner any results.
Virtual Psychological Services
Psychological testing is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As USCP is our client in wanting the outlined psychometric virtual testing, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. All our clinicians have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.
Psychological testing has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness, and helplessness because the process of live virtual psychological testing has been shown to have benefits for individuals who undertake it and requires a very active effort on your part.
Your one-time virtual session will involve a comprehensive evaluation of your psychological temperament and personality. Within 48-hours of the live, virtual testing and evaluation, our clinical team will be contacting United States Capitol Police (USCP) to offer some initial impressions of what our work might include.
Professional Records
We are required to keep appropriate records of the virtual psychological assessment services that we provide. We maintain the same ethical standards of care as in traditional face-to-face psychological assessment services and your personal records are maintained in a secure location in the office. We keep records noting that you were remotely tested and evaluated, your psychological, medical, social, and treatment history records we receive from other providers, and copies of records we send to others.
Confidentiality
Our policies about confidentiality, as well as other information about your privacy rights, are fully described in a separate document entitled Notice of Privacy Practices pamphlet. You have been provided with a copy of that document and we can discuss those issues in the clinical interview. Please remember that you may reopen the conversation at any time today. We will be sharing your psychometric assessment results with the United States Capitol Police as a part of your application process. However, your data may be used to conduct research that will not be attributed to you as an individual but as part of a collective group.