A to Z Behavioral Services Telehealth and Virtual Services Consent Protocol

A to Z Behavioral Services is committed to providing high-quality behavioral services through various methods, including telehealth and virtual platforms. This consent protocol outlines the terms and conditions under which telehealth services will be provided, ensuring that clients and their families fully understand and agree to the use of audio and video communication for service delivery.

Definition of Telehealth Services

Telehealth services involve the use of audio and video communication technologies to deliver behavioral health services remotely. These services may include assessments, consultations, parent training, therapeutic interventions, and progress monitoring.

Consent for Telehealth Services

By signing this consent form, you agree to receive behavioral health services via telehealth, including both audio and video communications. You acknowledge that:

• Telehealth services are conducted using secure, HIPAA-compliant platforms.
• The quality of telehealth services may be affected by technical difficulties such as poor internet connection or other unforeseen technical issues.
• Telehealth services may not be the same as in-person services and may have limitations in certain situations.

Request for In-Person Services

Families may request in-person services at any time by submitting a written request to A to Z Behavioral Services. While every effort will be made to accommodate such requests, in-person services are not guaranteed and will be subject to availability, staffing capacity, and health and safety guidelines.

Confidentiality

All telehealth services will be conducted in a private setting to maintain confidentiality. Clients and their families are responsible for ensuring that they are in a private location during telehealth sessions. A to Z Behavioral Services will take all reasonable measures to protect the confidentiality of your information in accordance with HIPAA regulations.

Risks and Benefits

You understand that telehealth services offer convenience and increased access to care but may also present certain risks, including but not limited to:

• Disruptions due to technical failures
• Potential breaches of privacy despite security measures
• Limited ability to respond to emergencies

Consent Acknowledgment

By continuing, you acknowledge that you have read and understood the information provided above, and you voluntarily consent to participate in telehealth services provided by A to Z Behavioral Services. You understand that you may withdraw your consent at any time by providing written notice, though this may impact the continuity of care.

If you have any questions or concerns, please contact A to Z Behavioral Services for further clarification.