Introduction

This document provides important information about using telemental health services as part of your psychotherapy and/or psychiatry at Perlman Clinic. Telemental health delivers clinical health care services through technology-assisted media or other electronic means between a practitioner and a client in different locations.

Key Points to Understand

1. Right to Withdraw: You can withdraw consent for telemental health services at any time. This will not affect your right to future care, services, or program benefits.
2. Risks and Benefits: Telemental health has potential risks and benefits. These include:
   • Possible technology failures, interruptions, or breaches of confidentiality.
   • Limited ability to respond to emergencies.
   • Uncertain or unguaranteed results.
   • Your provider may determine that telemental health isn’t suitable for your care and may recommend alternative options.
   • Security protocols may fail.
3. Confidentiality:
   • No recording of online sessions.
   • All disclosed information is confidential and will not be shared outside of Perlman Clinic without written authorization, except where required by law.
4. Privacy Laws:
   • Privacy laws protecting your health information apply to telemental health, except in specific situations (e.g., mandatory reporting of abuse, danger to self or others, legal proceedings).
   • As an integrated care network, Perlman Clinic collaborates with primary care physicians and various specialists. Your mental health records may be accessed by other team members and providers involved in your care or those with legitimate reasons for accessing your medical information.
   • Perlman Clinic participates in an Organized Health Care Arrangement (OHCA) with UCSD Health System for HIPAA compliance. Mental health information may be shared within the OHCA for treatment, payment, or healthcare operations.
   • UCSD has its own Notice of Privacy Practices.
5. Crisis Situations:
   • If you experience a mental health crisis that cannot be resolved remotely, telemental health services may be deemed inappropriate, and a higher level of care may be necessary.
6. Technical Difficulties:
   • If technical issues occur, try ending and restarting the session.
   • If unable to reconnect within ten minutes, call the clinic at 858-250-0286.
7. Late Fees:
   • A $75.00 fee applies for late cancellations (within 24 hours) or missed appointments.
8. Emergency Contact:
   • Your therapist may need to contact your emergency contact and/or authorities in an emergency.

Emergency Protocols

• Please provide your current location at the start of each session.
• Provide a contact person who can be reached in a life-threatening emergency. This person may be contacted to go to your location or take you to the hospital if needed.

By proceeding with telemental health services, you acknowledge that you have read and understood this information.

Please note: This document is a summary and may not include all details. Please consult with your provider/therapist for further clarification.