This Consent to Use Telehealth Services contains important information you should be aware of before receiving behavioral health services through electronic communications with your Hey Jane Provider (“Provider”).
You have agreed to receive individual therapy and/or medication management/pharmacologic treatment or related behavioral health services from a Hey Jane Provider using the Hey Jane telehealth platform. Your Provider will be relying on all information you provide such as your age, location, medical and behavioral health history, and responses to the intake questions. Neither your Provider nor Hey Jane will be responsible if such information is not accurate.
Benefits of Telehealth
Telehealth refers to the provision of healthcare services via telecommunications technologies, such as video conferencing, telephone or other synchronous or asynchronous technologies. One of the benefits of Telehealth Services is that the patient and clinician can exchange information and engage in the delivery of behavioral health services without being in the same physical location. Telehealth Services can expand access to care and help ensure continuity of care.
There are many ways that technology issues might impact Telehealth Services beyond the control of the Provider including loss of internet connection, transmission failure or other technical failure that might result in interruption or unintended termination of the session or exposure of your personal information.
Utilization of Telehealth Services requires you to have access to certain technologies. You are solely responsible for any mobile charges or cost to you to obtain any necessary equipment, accessories, or software to engage in Telehealth Services.
We will make every effort to protect the privacy of all communications associated with Telehealth Services and comply with all federal and state laws that govern your personal and health information. You should also take reasonable steps to protect the privacy of the communications by finding a private location without interruption. Given the nature of electronic communication technologies, we cannot guarantee the confidentiality of our communications, or protection against unauthorized access to our communications. We will take all reasonable measures to help keep your information private, but please be aware of the risk that electronic communications may be compromised, unsecured, or accessed by others. You should protect the confidentiality of our communications by, for example, only using secure networks for Telehealth Services and using passwords to protect the device you use for Telehealth Services.
Telehealth Services are not intended to be, and do not act as, emergency services. If you are experiencing an emergency, you should not rely on Telehealth Services and instead should call 911 or go directly to the nearest hospital emergency room.
In case of an emergency and we are unable to reach you, your Hey Jane Provider may reach out to the individual whom you have named as your emergency contact.
Release of Records
From time to time, you may request that we refer you to other providers for medication management or other professional services or send your record to your another one of your providers. In that event, we will request that you complete an authorization to release your records.
I acknowledge that I have read and understand the risks, limitations, and instructions for use of Telehealth Services described in this Consent to Use Telehealth Services. I acknowledge that I can withdraw my consent to receive Telehealth Services without affecting my right to future care or treatment. I also understand that it is my responsibility to contact my Provider with any questions or concerns about Telehealth Services. By participating in Telehealth Services, I acknowledge and agree that I have no questions or concerns that would preclude me from participating in Telehealth Services.