Comprehensive Psychiatric Evaluation

We cannot ensure the confidentiality of any form of communication through electronic media, including, but not limited to, text messages, telephone communication, the Internet, facsimile machines, and e-mail. Telemedicine is broadly defined as the use of information technology to deliver medical services and information between two parties that are at different locations. The above electronic means of communication are considered telemedicine. Utilizing telemedicine services through (Purple Health Wellness) is voluntary in nature and you need to understand: You have the right to withhold or withdraw your consent for telemedicine services at any time. If this occurs, you need to understand that we cannot provide care for you any longer as (Purple Health Wellness) strictly a telemedicine practice. Purple Health Wellness will protect your protected health information in the same fashion as a brick and mortar practice. You need to understand though that data breaches can happen, and we cannot assure your information is 100% protected. We will not use your protected health information for research purposes unless you give us consent to do so. There are potential benefits, risks and subsequent consequences of telemedicine. Potential benefits include, but are not limited to improved access to care, reducing costs, improving the quality of visits, and reduction of travel time associated with medical visits. The medical provider will make assessments, diagnoses, and treatment plans based off all the visual and auditory information provided during the video conference. You must understand that this is limited and posts potential risks including, but not limited to the provider’s inability to make complete diagnostic assessments that might require a physical exam and to see the patient in person. During an in-person encounter, a medical provider has the ability to see the entire patient including but not limited to their gait, smell, general appearance, and demeanor. Potential consequences thus include the provider not being aware of clinically significant information that you may not recognize as significant to present verbally to the provider. In reading this document, you agree to begin treatment with the policies above and acknowledge receipt of the Privacy Notice.