TeleMedicine

Connecting with a Provider just got easier

Keeping you and our community healthy and safe, as well as maintaining mental well-being, have always been and remain our top priorities. As we face challenges presented by COVID-19, we also strive to provide the care and support you and your family need to stay healthy — physically, mentally and emotionally.

What is TeleMedicine?

Quality Care at Your Convenience

Simply put, TeleMedicine enables you to remotely connect with clinicians for healthcare services and information by phone, tablet or computer. Utilizing user-friendly, HIPAA-compliant video and communications technology, this service allows you to see and speak with one of our professionals just as you would during an in-person consultation — all in real time, respectful of social distancing practices, and from your own home, office or anywhere you may be.

1.Complete the TeleMedicine Consent Form at the bottom of this page

2. Go to http://psot.doxy.me

(Alternatively your provider may also send you an email 10-15 minutes prior to your appointment.)

3. Choose your Provider.

4. Key in the Patient’s name.

5. Call office for Follow up in time frame discussed with provider.

6. If you have any problems or need to be seen sooner call office to move appointment.

TeleMedicine Consent Form

Please enable JavaScript in your browser to complete this form.

By signing this form, I understand and agree with the following:
Telehealth/Telemedicine involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists and/or subspecialists, nurse practitioners, registered nurses, medical assistants and other healthcare providers who are part of my clinical care team. In addition to myself and the members of my clinical care team, my family members, caregivers, or other legal representatives or guardians may join and participate on the telehealth/telemedicine service, and I agree to share my personal information with such family members, caregivers, legal representatives or guardians. The information may be used for diagnosis, therapy, follow-up and/or education.
Telehealth/Telemedicine requires transmission, via Internet or tele-communication device, of health information, which may include:
• Progress reports, assessments, or other intervention-related documents
• Bio-physiological data transmitted electronically
• Videos, pictures, text messages, audio and any digital form of data
The laws that protect the privacy and confidentiality of health and care information also apply to telehealth/telemedicine. Information obtained during telehealth/telemedicine that identifies me will not be given to anyone without my consent except for the purposes of treatment, education, billing and healthcare operations. By agreeing to use the telehealth/telemedicine services, I am consenting to Psychiatric Services of South Texas sharing of my protected health information with certain third parties as more fully described in Psychiatric Services of South Texas Privacy Policy. I understand, agree, and expressly consent to Psychiatric Services of South Texas obtaining, using, storing, and disseminating to necessary third parties, information about me, including my image, as necessary to provide the telehealth/telemedicine services.
As with any Internet-based communication, I understand that there is a risk of security breach. Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. Individuals other than my clinical care team or consulting providers may also be present and have access to my information for the telehealth/telemedicine session. This is so they can operate or repair the video or audio equipment used. These persons will adhere to applicable privacy and security policies.
Telehealth/telemedicine sessions may not always be possible. Disruptions of signals or problems with the Internet’s infrastructure may cause broadcast and reception problems (e.g., poor picture or sound quality, dropped connections, audio interference) that prevent effective interaction between consulting clinician(s), participant, patient or care team.

Agree#1

I hereby release and hold harmless Psychiatric Services of South Texas and all members of my care team from any loss of data or information due to technical failures associated with the telehealth/telemedicine service.

Agree#2

I understand and agree that the health information I provide at the time of my telehealth/telemedicine service may be the only source of health information used by the medical professionals during the course of my evaluation and treatment at the time of my telehealth/telemedicine visit, and that such professionals may not have access to my full medical record or information held at Psychiatric Services of South Texas.

Agree#3

I understand that I will be given information about test(s), treatments(s) and procedures(s), as applicable, including the benefits, risks, possible problems or complications, and alternate choices for my medical care through the telehealth/telemedicine visit.

Agree#4

I have the right to withhold or withdraw consent to the use of telehealth/telemedicine services at any time and revert back to traditional in-person clinic services.

Agree#5

I understand that if I withdraw my consent for telehealth/telemedicine, it will not affect any future services or care benefits to which I am entitled.

Agree#6

All my questions have been answered to my satisfaction.

Agree#7

I hereby consent to the use of telehealth/telemedicine in the provision of care and the above terms and conditions.

Electronic Signature Agreement:
I, the undersigned, agree and understand that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian.

By electronically signing below, I certify that I am the legal representative of the participant or that I am the patient and am 18 years of age or older, or otherwise legally authorized to consent. I have carefully read and understand the above statements. I have had all my questions answered. I understand that this informed consent will become a part of my medical records.

First

Middle

Last

Date:

If you have any questions call us on (361) 452-1151