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Completely Centered Health, LLC. Telehealth Overview and Acknowledgement

PURPOSE:
To ensure adherence to all applicable laws, rules, and regulations while ensuring patient access to Psychiatry through the use of “live two-way audio-visual communication”. By implementing these procedures, (Completely Centered Health, LLC) will provide “long-distance” medical services to patients.

TELEHEALTH OVERVIEW

I. DEFINITIONS
Telepsychiatry - Telepsychiatry, also called telehealth mental health or teletherapy, can involve direct interactions that are done through a HIPPA compliant video chatting platform, or other means such as, talking, between patients and psychiatrists, as well as psychiatrists supporting primary care providers with mental health consultations and expertise.

Telemedicine- The use of electronic communication and information technologies to provide or support medical care at a distance. This definition includes: (1) live interactive two-way audio-video communication; and (2) any communication modalities such as phone, fax, e-mail, the internet, and still imaging that are used in conjunction with such live two-way audio-video communication. The same standards of care and protocol exist with telemedicine as are used when assessing and treating the patient on-site. The provider-patient relationship is the same. Even though an “in-person” examination is not performed, a physical inspection is performed utilizing the video chat, and a thorough history, assessment, plan, and laboratory evaluation is performed thus establishing a provider-patient relationship.

Medical Providers/Providers – A licensed MD, DO, NP, or PA.

II. APPLICATIONS/SCOPE
A. Services
1. The following services will be available through the use of telemedicine:
• Psychiatric Evaluation Initial assessment
• Medication Management
• Psychotherapy

2. Treatment via telemedicine will not deviate from standards of care applicable to face-to-face assessment and treatment.

3. Telemedicine (telepsychiatry) by the medical provider may be an adjunct to periodic face-to-face contact or it may be the only contact by the medical provider if the medical provider deems it unnecessary to have an in-person evaluation.

B. Locations
Telepsychiatry medical services will be provided as follows:

1. Patient at the remote location/Provider at a remote location – Medical provider will be at a location of their choosing operating under Completely Centered Health, LLC, and the patient will be at a location of their choosing such as their home.

C. Clinical Oversight
Clinical oversight of telepsychiatry medical care will be provided by random audits of patient charts by the Completely Centered Health clinical directors.

Medical providers will have access to clinical directors for clinical questions as they arise.

D. Contraindications for Use
The consulting provider should request face-to-face consultation if the patient's condition does not lend itself to a telemedicine consultation or if visual or sound quality is inadequate.

III. PRIVACY, CONFIDENTIALITY AND SECURITY
A. The privacy and confidentiality of the telemedicine medical service will be maintained by ensuring that the locations of the patient and medical provider are secure. The services will be provided in a controlled environment (closed doors) where there is a reasonable expectation of absence from intrusion by individuals not involved in the patient's direct care.

B. “Do Not Enter” signs will be recommended to be posted on the outside doors of facilities used in order to notify individuals not to enter the room during the telemedicine visit.

C. Completely Centered Health, LLC staff, or ancillary contracted staff, involved in the patient’s care, family members, and technical staff may at times be present in interviews. Patients will be informed about others present in the room at the distant site if such persons are off-camera and appropriate authorizations for disclosure of information will be obtained. Whenever possible, the presence of non-clinical staff during the telemedicine visit will be avoided.

D. The telemedicine medical service will not be audio or video-taped without written informed consent from the patient.

IV. INFORMED CONSENT
A. Informed consent for telepsychiatry and telemedicine services will be obtained from the patient prior to the service.

B. The patient will be made aware of the potential risks and consequences as well as the likely benefits of the telemedicine, telepsychiatry services and will be given the option of not participating. If patients choose to not participate in the care provided by (Completely Centered Health, LLC), the provider will refer the individual to (PCP OR SPECIALIST) for further management.

C. The content of the consent will be discussed fully, and a note documented in the record that this has occurred.

D. The original signed consent will be filed in the patient’s medical record.

V. REQUIRED DOCUMENTATION
A. All documentation of medical services will be documented in accordance with applicable standards, guidelines, by-laws, rules, and regulations. Providers will be expected to document in the provided cloud-based EMR.

B. A Progress Note will be completed by the medical provider to document each visit with the patient. The progress will be completed within 24 hours of the visit.

C. Upon admission to (Completely Centered Health, LLC ), an initial visit will be conducted by the medical provider and documented in the patient’s record.

D. Prescriptions will be documented within the EMR for each patient every time a prescription is issued.

E. Orders for lab work and notation of review of lab work will be documented in the progress notes.

F. When equipment failure prevents adequate diagnosis or treatment, a progress note should be written to document such failure and later transcribed into the EMR.

VI. MEDICAL RECORDS
A. Medical records will be saved in the cloud-based EMR and are available/accessible for routine care and in emergency situations.

VI. EQUIPMENT FOR VIDEOCONFERENCING
A. All medical providers will be expected to have a personal computer, laptop, or tablet that is capable of video conferencing and operating the EMR.

VIII. SPECIFIC OPERATING PROCEDURES AND EXPECTATIONS
A. Scheduling of appointments for medical services will be predominately performed online through the cloud-based EMR scheduling portal accessed from the website. Patients will select the medical provider based on available open times and create an appointment. If a patient calls requesting an appointment, they will be directed to the online portal and will make the appointment themselves.

B. Completely Centered Health, LLC answering service will respond within 24 hours to your needs. This answering service will be responsible for answering patient’s basic questions, coordinating schedules, and referring to medical providers as necessary.

IX. PROVIDER RESPONSIBILITIES
A. Provider will be responsible for answering clinically relevant questions, concerns, or urgent/emergent matters that patient needs. The provider will be responsible to address these matters for the patients they provide care to. It will be expected that the matter will be addressed within 2 hours of notification. The provider is responsible for this during the hours of 8 AM - 9 PM. The provider should anticipate this happening very sparingly as telepsychiatry is well tolerated by most patients.

B. Provider will be responsible for ordering labs through the (Access Lab) portal at the end of the patient encounter. The provider is responsible for entering the patient’s demographic data into this lab portal and initiates the order. After the order is placed into the (Access Lab) portal, the provider must also input the lab charge into the EMR.

C. Provider is responsible for reviewing the patient’s lab work prior to the initiation of the follow-up visit. It is the clinical director’s responsibility to address critical values that the lab will call into (Access Lab).

D. Prescriptions will be called in or eRx by the provider.
1. It is the provider's responsibility to ensure they follow lawful prescribing of controlled substances. It is the provider's responsibility to coordinate an in-person evaluation prior to the prescription of a controlled substance. Prescriptions for a controlled substance should not exceed the amount permitted by law.

E. Scheduling
1. During this initial consultation it is the provider's responsibility to ensure the informed consent is reviewed, absolute and relative contraindications are assessed and a complete history is performed.

2. After the initial consultation, lab work will be ordered and the follow-up visit will be scheduled in 2-4 weeks. This follow-up visit is when lab work will be reviewed, and a plan will be started.

F. It is the provider’s responsibility to stay up to date in current medical practices regarding psychiatry.

G. It is the provider’s responsibility to educate the patient about the importance of establishing, following up, and maintaining care with a primary care provider outside of services provided by Completely Centered Health, LLC.

H. It is at the provider’s discretion to obtain a full physical examination of the patient prior to initiating treatment. An inspection examination will be performed during the initial video visit. A physical exam can be done by the patient's primary care provider or at urgent care and sent to Completely Centered Health, LLC.

TELEHEALTH CONSENT AND ACKNOWLEDGEMENT
1. I understand that I am voluntarily engaging in a telemedicine consultation with Completely Centered Health, LLC.

2. I understand that the video conferencing technology and/or phone consultations will not be the same as a direct patient/health care provider visit due to the fact that I will not be in the same room as my health care provider.

3. I understand that a telehealth consultation has potential benefits including easier access to care, decreasing costs, and allowing visits to be performed from the comfort of my home.

4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

5. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. I understand that if there is another individual present during the telehealth consultation that I will be informed of their presence and I will also disclose if there is another individual with myself. It is agreed that these individuals will maintain the confidentiality of the information obtained. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/physical examination that are personally sensitive to me; (2) ask non‐medical personnel to leave the telemedicine examination room: and or (3) terminate the consultation at any time.

6. I understand that the alternative to a telemedicine consultation is to forgo evaluation and treatment with Completely Centered Health, LLC and to seek out an in-person evaluation elsewhere. Thus, I am freely choosing to participate in a telemedicine consultation.

7. I understand that telemedicine has limitations in regard to physical examination. I understand that the physical exam portion of the care provided through (Completely Centered Health, LLC ) will be limited to inspection via video conferencing, and some parts of the exam such as physical tests, examination of certain body parts, and vital signs may be conducted by individuals at my location at the direction of the consulting health care provider or not done at all.

8. Telemedicine services offered through (Completely Centered Health, LLC) are not an Emergency Service and in the event of an emergency or urgent medical issue, I will use a phone to call 911, go to the emergency department, or go to an urgent care.

9. To maintain my privacy, I will not share telemedicine login information or video conferencing links with anyone unauthorized to attend the appointment.