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Supplemental Telehealth Informed Consent
Georgia Gwinnett College
Counseling & Psychological Services
Building I, Suite 1101
Lawrenceville, Georgia 30043
I ___ (name of student) hereby consent to
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How to fill out supplemental telehealth informed consent
How to fill out supplemental telehealth informed consent
01
Start by obtaining the supplemental telehealth informed consent form. This form can typically be found on the website of the healthcare provider or telehealth platform you are using.
02
Read through the form carefully to understand its contents and requirements.
03
Fill out the personal information section of the form, providing your full name, date of birth, address, and contact information.
04
Review the privacy and security section of the form, which typically outlines how your personal health information will be protected during the telehealth session.
05
Sign the informed consent form to indicate your agreement to participate in the telehealth session and your understanding of the potential risks and benefits.
06
If required, provide any additional information or documentation requested on the form, such as your insurance details or medical history.
07
Submit the completed form to the healthcare provider or telehealth platform as instructed. This is usually done electronically through the telehealth platform or via email.
08
Keep a copy of the filled-out form for your records.
Who needs supplemental telehealth informed consent?
01
Supplemental telehealth informed consent is typically required for individuals who are seeking to participate in telehealth sessions with healthcare providers or practitioners. This may include patients who are undergoing remote consultations, mental health counseling, or other forms of medical or healthcare services through telecommunication technologies. It is recommended to check with the specific healthcare provider or telehealth platform to determine if a supplemental telehealth informed consent form is required.
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What is supplemental telehealth informed consent?
Supplemental telehealth informed consent is a form that patients must fill out in addition to regular consent forms before receiving telehealth services.
Who is required to file supplemental telehealth informed consent?
Patients who are opting to receive telehealth services are required to file supplemental telehealth informed consent.
How to fill out supplemental telehealth informed consent?
Supplemental telehealth informed consent can be filled out electronically or on paper, and patients must provide their personal information and consent information.
What is the purpose of supplemental telehealth informed consent?
The purpose of supplemental telehealth informed consent is to ensure that patients understand the risks and benefits of receiving telehealth services.
What information must be reported on supplemental telehealth informed consent?
Supplemental telehealth informed consent must include patient's personal information, consent for treatment, and acknowledgment of telehealth risks.
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