INFORMED CONSENT FOR TELEPSYCHOLOGY SESSIONS Logo
  • INFORMED CONSENT TELEPSYCHOLOGY

  • The Informed Consent for Telepsychology contains important information about doing psychotherapy using either a telephone or a HIPAA approved telehealth platform. Due to the ongoing presence of Covid-19, telepsychology allows individuals to follow CDC guidelines as well as not to disrupt ongoing mental health counseling. Genesis recognizes the importance of not disrupting the counseling process. Therefore, if in-person visits are not feasible, telepsychology is available for you to meet with your therapist.

    Benefits and Risks of Telepsychology

    There are some differences between in-person psychotherapy and telepsychology as well as some risks.

    Here are some examples:

    • Risks to confidentiality. Because telepsychology sessions take place outside of the therapist’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. Genesis’ therapists will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for the session where you will not be interrupted. It is also important for you to protect the privacy of the session on your cell phone or another electronic device. Your therapy session should occur in a room or area where others are not present and cannot overhear.

    • Issues with Telepsychology. There are many ways that technology issues might impact telepsychology. As an example, technology may stop working during a session, other people might be able to get access to your private conversation, or stored data could be accessed by unauthorized people or companies.

    • Crisis management and intervention. Genesis’ therapists recognize that telepsychology is not an appropriate intervention for crisis management. If a client is in crisis, Genesis’ therapist will advise you to call 911 or go to your nearest emergency room.


    Electronic Communications

    There are several HIPAA compliant virtual platforms designed to provide telepsychology. Your therapist will provide you with the name and the link for your appointment. It is important to have a good internet connection and electronic device to provide good service. If you are unable to access the internet, you will be able to have therapy via telephone. You are solely responsible for any cost to you to obtain any necessary devices, accessories, and/or software to participate in, telepsychology.

    Confidentiality

    The Genesis Therapy Center has a legal and ethical responsibility to make best efforts to protect all communications that are a part of telepsychology. However, the nature of electronic communication devices cannot guarantee that communications will be kept confidential or that other people may not gain access to these communications. As with any electronic communication may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of communications (for example, only using secure networks for telepsychology sessions and having passwords to protect the device you use for telepsychology).

    The extent of confidentiality and the exceptions to confidentiality remain the same as outlined in the Client Information and Informed Consent (signed prior to/during your intake session) and still apply in telepsychology. As well, so does the emergency procedures. Should a crisis arise, call 911 or go to your nearest emergency room. Please let your therapist know if you have any questions about exceptions to confidentiality or the emergency procedure.

    Assessing and evaluating threats and other emergencies can be more difficult when conducting telepsychology than in traditional in-person therapy. To address some of these difficulties, we will create an emergency plan before engaging in telepsychology services. We will ask you to identify an emergency contact person who is near your location and who we will contact in the event of a crisis of emergency to assist in addressing the situation. By signing this form, you are allowing us to contact your emergency contact person as needed during such a crisis or emergency.

     

  • If the session is interrupted for any reason, such as technological connection fails, and you are having an emergency, do not call your therapist back; instead, call 911 or go to your nearest emergency room. Call your therapist back after you have called or obtained emergency services.

    If the session is interrupted for any reason and you are not having an emergency, disconnect from the session and we will wait (2) minutes and then attempt to reconnect via the telepsychology platform on which we agreed to conduct therapy. If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time.

    Insurance Fees

    Due to the ongoing challenges with Covid-19, insurance companies have approved
    telepsychology as a platform for individuals to continue ongoing mental health treatment. As a client, you are responsible to verify coverage and the parameters your policy requires for telepsychology. Genesis will discuss options within these guidelines and submit billing to your insurance based on the services provided. Clients will be responsible for any charges deemed their responsibility by the insurance provider.

    Self-Pay

    If you are paying for your telepsychology sessions out of pocket, you and your therapist have determined the cost of each session. Payment for the session is due at the conclusion of your appointment. In addition, you will have the option to leave a credit card on file to cover ongoing telepsychology appointments.

    Records

    The telepsychology sessions will not be recorded in any way unless agreed to in writing by mutual consent. Genesis will maintain a record of the telepsychology session in the same manner as in-person sessions.

    Informed Consent

    This agreement is intended as a supplement to the Client Information and Informed Consent signed and agreed to at the onset of our clinical work together and does not amend any of the terms of that agreement.


    Your signature below indicates agreement with its terms and conditions.

     

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