If you and your provider chooses to use information technology for some or all of your treatment, you need to understand that:
(1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
(2) All existing confidentiality protections are equally applicable.
(3) Your access to all medical information, if recorded during a telehealth consultation, is guaranteed, and copies of this information are available for a reasonable fee.
(4) Dissemination of any of your identifiable images or information from the telehealth interaction to researchers or other entities shall not occur without your consent.
(5) There are potential risks, consequences, and benefits of telehealth. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to treatment, better continuity of care, and reduction of lost work time and travel costs.
The use of HIPAA compliant video communication and/or video recording may be used by licensed providers to facilitate a session, to facilitate in-house training and quality of service improvements, or for licensed supervision of our Associate Licensed providers, and without written refusal from you, you are expressly giving us consent for such use at any time without notice. You have a right to withdraw this consent at any time without affecting your right to any service to which you may be entitled.