Telepsychiatry Consent to Treatment

Austin Mind and Behavioral Health

Telepsychiatry refers to the use of interactive audio and visual electronic systems to provide psychiatric (or psychotherapeutic) care, where the provider and the patient are not in the same physical location. The telepsychiatry may include consultation, collection and gathering of information, diagnosis, treatment, treatment recommendations, telephone conversations, email, and health education.

The telepsychiatry service will be provided using a secure HIPAA-compliant interactive electronic system that incorporates network and software security protocols to protect patient information and safeguard the data exchanged.

Benefits of Telepsychiatry:

• Convenience and accessibility for patients unable to attend face-to-face visits due to distance or physical limitations.

Potential Risks of Telepsychiatry:

• Dependence on third-party internet connectivity and technology, which may result in service interruptions due to hardware, software, power failures, or network issues.
• Possibility of distorted or unclear transmission of information (e.g., poor audio or visual quality) that could impair clinical decision-making.
• The provider may not be able to offer treatment or emergency care in certain situations.

My Rights:

• I have the right to withdraw consent for telepsychiatry services at any time without affecting my current or future care.
• The same confidentiality and privacy laws that apply to in-person visits also apply to telepsychiatry.
• Texas laws and regulations governing medical practice apply to telepsychiatry services.
• The provider or clinic may also withdraw consent for telepsychiatry at any time.
• Sessions will not be recorded or observed without my written consent, and I agree not to record them either.

My Responsibilities:

• I will use a computer with a webcam, microphone, and internet connection in a quiet, private setting.
• I am responsible for the security of communications on my devices and the location I choose for sessions.
• I will protect my login credentials and ensure no one else accesses my telepsychiatry services.
• I understand the provider uses a HIPAA-compliant third-party service for telepsychiatry and is not responsible for that company's operations or data security.
• I am responsible for providing and maintaining the equipment necessary for telepsychiatry sessions.
• I understand that all clinic policies apply to both telepsychiatry and in-office visits.
• I agree to attend at least one face-to-face in-office visit per year, or as directed by my provider, to maintain the therapeutic relationship.
• I understand there may be a telepsychiatry surcharge for technical support and equipment costs, which will be disclosed in writing and agreed upon prior to the session. This fee is not covered by insurance and may be waived at the provider’s discretion.

Patient Consent to Use Telepsychiatry Services:

I have read and understand the information provided above regarding telepsychiatry. I have discussed this information with my provider or clinic staff, and all my questions have been answered. I hereby give my informed consent for the use of telepsychiatry in my medical care and authorize the provider to use telepsychiatry in the course of my diagnosis and treatment.