At present I am not seeing clients in my office.  I am doing therapy through HIPAA compliant  video-conferencing: “Telepsychology”

 

1. Prior to our first meeting I will need you to complete several forms below. Download and print by clicking on the green links below.     (a pdf reader such as Adobe Reader is required).  

(If you cannot download,  I can send them via e-mail or USPS mail)

Registration Form

Client Intake Form

Office Policy/Informed Consent

HIPAA Privacy Practices

2. Be sure to include a copy of your insurance card(s).

3. In addition, read the “Telepychology” dislosure below. I will ask you for verbal agreement to proceed at our first meeting. A copy can be emailed to you if you like. 

TELEPSYCHOLOGY INFORMED CONSENT

Telepsychology refers to providing psychotherapy remotely using telecommunications technologies such as videoconferencing and telephone.  Recent research is showing that Telepsychology can be as effective as in-office face to face interactions under various conditions. Telepsychology requires basic familiarity with the technology involved on both of our parts.  The technology platform I use is called VSee(www.vsee.com) and it is cost-free to you.  VSee is a HIPAA compliant platform that is owned and maintained by an independent third party technology company that I have a federally compliant “Business Associate Agreement” with.  There are benefits and potential downsides associated with Telepsychology that I will briefly outline below.  Please feel free to ask me any questions about what you read below.

BENEFITS

1. Telepsychology services are now covered by most insurance plans, including Medicare (since the onset of the Covid-19 pandemic —whether Medicare continues coverage into the future is not guaranteed at this time.)
2. We can engage in therapy without being in the same physical location. This means we can maintain continuity of care if you move, take an extended vacation, or if either of us are otherwise unable to meet at my office.   Being that I am licensed in California and Washington State I can legally provide psychological services to clients who are residents of California and Washington State. 
3. Telepsychology makes therapy more convenient and involves less overall time (including transportation).

POSSIBLE DISADVANTAGES AND RISKS

1. It is important for you to find a private location for our appointment where you have no interruptions, eavesdropping or intrusions by others. It is also important for you to protect the privacy of the devise you use when participating in the Telepsychology sessions.
2. Generally, there may be times when the technology may encounter interruptions or stop working due to loss of signal. Possibly, others may be able to access our private conversation, and/or stored data may be accessed by unauthorized people or organizations.  I do not keep recordings of sessions or electronic records of our meetings, so unauthorized access to your personal data by others is extremely unlikely.
3. Crisis Management and intervention may be more complicated as a result of being in different locations. Before beginning Telepsychology services, we will need to establish crisis management and emergency response plans to insure your safety and welfare.
4. Some Psychologists believe that something may be lost in the absence of being in the same room. For example, being that therapy involves both verbal and non-verbal communication.  The video stream typically does not show of full picture of you, and the audio levels may be inadequate at times, some non-verbal signals and communication may be unobserved and/or lost.  I observe and listen carefully when doing Telepsychology, and if I suspect I am missing something, I will point it out to you.  I would also expect if you feel you are missing something in my communications, you would address it with me.

 ELECTRONIC COMMUNICATIONS

1. We will decide together which type of devices (i.e. computer, tablet, telephone) we will use to communicate. I ideally prefer video/audio streaming.  Insurance companies require that a HIPAA compliant video teleconference platform (such as VSee) be used to meet reimbursement requirements. Clients are responsible for any costs associated with purchasing and maintaining equipment, accessories and/or software. 
2. For communication between sessions, I typically only use telephone and voicemail for messaging. On rare occasions I may text message.  I do not use email for between session therapy communications, but there may be times when non-confidential exchange of documents may occur (i.e blank forms to be completed by you such as registration forms, release of information forms, etc…)

 CONFIDENTIALITY

1. The same state and federal laws concerning confidentiality for in-office sessions apply to Telepsychology, Exceptions to confidentiality are outlined in my Informed Consent/Office Policies Statement.

 EMERGENCIES, URGENT SITUATIONS, AND TELEPSYCHOLOGY

1. Assessing threats and emergencies can be more difficult via Telepsychology than office visits. To address some of these difficulties, we will need to create and emergency plan before engaging in Telepsychology services.  I will ask you to identify at least one emergency contract who is near your location and who I may contact if I determine the need in case of crisis or emergency.  Below is a space to list emergency contacts.  Additionally, you may need to sign an authorization enabling me to contact such persons.
2. If a session is interrupted for any reason (such as technology failure) and there is an emergency threatening your own or another’s life or safety, do not call me back first. Instead call 911, the county crisis or suicide hotline, or go to the nearest hospital emergency room.  Contact me by phone at 760-821-7250 or 206-240-9880 after you have called and obtained emergency services.
3. If a session is interrupted and there is no emergency, disconnect from the session and I will wait two (1) minute and attempt to re-connect with you either by Telepsychology platform or by telephone. If you do not hear from me within two (2) minutes, call me by phone at 760-821-7250 or 206-240-9880.
4. If there is a technology failure and we cannot resume our connection, you will only be charged the pro-rated amount of the actual session time.

      FEES

1. The same fees apply to Telepsychology as they do to office visits. All client financial accounts (insurance billing, insurance and client payments) are posted through an online service “Office Ally”.

RECORD KEEPING

1. Records, including progress notes for Telepsychology sessions are handled the same as for office visits. I do not keep electronic health records.  All records are kept as paper records in my office file cabinet.  I consider paper records more secure less prone to unauthorized disclosure than electronic records

INFORMED CONSENT

This agreement is intended as a supplement to the general Informed Consent/Office Policies statement signed at the outset of our working together.  This agreement does not amend or alter the terms of that agreement.

 Your signature or verbal agreement via Telepsychology (which I will note on the signature line) below indicates agreement with the terms and conditions discussed above, and gives permission to proceed with Telepsychology services.

 

 _______________________________________________________                                                                                                                                             

CLIENT SIGNATURE AND DATE 

 

_________________________________________________________                                      

Robert E Parker PhD                                                                                       

EMERGENCY CONTACT(S)

BY PROVIDING NAME(S) AND CONTACT INFORMATION DR. PARKER IS HEREBY GIVEN PERMISSION TO CONTACT ONE OR ALL OF THE EMERGENCY CONTACTS AND PROVIDE ONLY AS MUCH INFORMATION NECESSARY ON A “NEED TO KNOW BASIS”

NAME / RELATIONSHIP/ CONTACT PHONE# 

1.  ____________________________________________________________

2.  ____________________________________________________________