Telehealth Informed Consent

Lavender Integrative Psychiatry offers telehealth services using secure electronic communication platforms. Telehealth allows psychiatric services to be provided remotely using audio and/or video technology.

By participating in telehealth services, you acknowledge and agree to the following:

1. Nature of Telehealth

Telehealth involves the use of electronic communications to enable healthcare services when the provider and patient are not in the same physical location.

Telehealth may include:

• Psychiatric evaluations
• Medication management
• Follow-up appointments
• Consultation

2. Potential Benefits

Telehealth may:

• Improve access to care
• Reduce travel time
• Increase scheduling flexibility

3. Potential Risks

Telehealth carries certain risks, including:

• Technical failures
• Interrupted or poor quality audio/video
• Unauthorized access despite security safeguards
• Limitations in the provider’s ability to respond to emergencies remotely

No technology platform is completely secure.

4. Confidentiality

Reasonable safeguards are used to protect privacy and confidentiality in accordance with HIPAA and applicable Massachusetts law.

Patients are responsible for participating in telehealth sessions from a private location to reduce the risk of unauthorized access to information.

5. Emergency Situations

Telehealth is not appropriate for medical or psychiatric emergencies.

If you are experiencing a crisis, call 911 or go to the nearest emergency room.

During telehealth sessions, you may be asked to provide your current physical location and an emergency contact in case immediate assistance is required.

6. Technical Requirements

Patients are responsible for:

• Having a secure internet connection
• Using a compatible device
• Ensuring device security

If technical problems occur, the provider may attempt to reconnect or convert the session to telephone when clinically appropriate.

7. Consent and Right to Withdraw

Participation in telehealth is voluntary. You may withdraw consent to telehealth at any time and request in-person services if available and clinically appropriate.

8. Licensing and Jurisdiction

Telehealth services are provided in accordance with applicable state licensing laws. Patients must be physically located in a state where the provider is licensed at the time of service.

9. Acknowledgment

By scheduling or participating in telehealth services, you acknowledge that you have read, understood, and agreed to this Telehealth Informed Consent.

Contact Information

Lavender Integrative Psychiatry
Elizabeth Rose Lavender | PMHNP, AGNP
Email: info@lavenderintegrativepsychiatry.com
Website: www.lavenderintegrativepsychiatry.com
Phone: 774-209-2291