Client's Consent Agreement
I understand that I have the following rights with respect to telemedicine:
I agree to work with Hand In Crisis LLC to manage my therapeutic care coordination at this time of need.
I agree to release any medical information necessary for my care to HIC to help in coordinating my care.
The laws that protect the confidentiality of my medical information also apply to telemedicine. As such, I understand that the information disclosed by me during the course of my care coordination is generally confidential.
However, there are both mandatory and permissive exceptions to confidentiality, including, but not limited to reporting any expressed threats of violence towards an ascertainable victim or myself.