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Bradley J. Shaw, CRNP, FNPC, PMHNPBC 216 N. 2nd Street, Suite 5, Clearfield, PA 16830 Phone: 8142054025 Fax: 8142406632CONFIDENTIALTelepsychiatry Contract and Informed Consent PLEASE READ THIS DOCUMENT
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01
Obtain a copy of the still waters telepsychiatry informed consent form
02
Read through the form carefully and make sure you understand all the information provided
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Fill out your personal information accurately, including your name, address, contact information, and any relevant medical history
04
Sign and date the form to indicate that you have read and understood the contents
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Return the completed form to the appropriate party as instructed
Who needs still waters telepsychiatry informed?
01
Individuals seeking telepsychiatry services from Still Waters Telepsychiatry
02
Patients who are interested in receiving mental health treatment remotely
03
Anyone who wants to ensure that their informed consent is documented properly before beginning telepsychiatry services
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What is still waters telepsychiatry informed?
Still Waters Telepsychiatry Informed refers to the form that must be completed by individuals seeking psychiatric services through Still Waters Telepsychiatry.
Who is required to file still waters telepsychiatry informed?
Individuals seeking psychiatric services through Still Waters Telepsychiatry are required to file the informed consent form.
How to fill out still waters telepsychiatry informed?
To fill out the Still Waters Telepsychiatry Informed form, individuals need to provide accurate information about their medical history, consent to telepsychiatry services, and understand the treatment plan.
What is the purpose of still waters telepsychiatry informed?
The purpose of the Still Waters Telepsychiatry Informed form is to ensure that individuals understand the risks and benefits of telepsychiatry services, as well as their rights and responsibilities as patients.
What information must be reported on still waters telepsychiatry informed?
The Still Waters Telepsychiatry Informed form requires individuals to provide information about their medical history, consent to treatment, understanding of telepsychiatry services, and agreement to the treatment plan.
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