Informed Consent for Group Telehealth Services and Waiver of Liability

Informed Consent for Group Telehealth Services and Waiver of Liability

Group Telehealth Services :Tristate Bariatrics (“We”, “we”, “Our”, “our” or “us”) is currently using Microsoft Teams for group telehealth services. We reserve the right to change the telehealth platform we use at any time based on new information. You will be informed of any changes that occur.

  1. Confidentiality

Our personal commitment to maintaining confidentiality remains the same as stated in our

Informed Consent for Telehealth Services form. Because of the risks associated with using technology, however, we have a decreased ability to fully guarantee confidentiality of your information. To do our best, we require all participants to register for the group session and enter a waiting room for the provider to allow admission to the group will engage in-group telehealth services over a secure internet connection, and ensure our computers have anti-virus protection. We encourage you to take the same precautions to protect your information.

  • Potential Benefits to Group Telehealth Services

Telehealth services have potential benefits including easier access to care, continuity of care, increased social connection, and the convenience of meeting from a location of your choosing. Additional benefits to group telehealth services may include comfort in knowing you are not alone and that others have similar concerns or sources of stress, the opportunity to gain perspectives from multiple people rather than from one individual counselor, consistent meetings, and increased motivation to reach your goals due to a sense of accountability one might feel as a group member as well as receiving support from multiple people.

  • Potential Risks of Group Telehealth Services

There are potential risks to this technology, including interruptions, unauthorized access or breaches of information, and technical difficulties, which cannot be predicted or fully controlled. As with any therapy, we cannot make guarantees about the results of the telehealth services. People may also have increased difficulty reading non-verbal cues and knowing when to speak in order to avoid interrupting others. Please be patient with the facilitator and other group members in this process.

  •  Voluntary Participation and Termination

You should not participate in-group telehealth services other than on a voluntary basis. You have the right to withdraw from the group telehealth services at any time. We ask that you inform the group facilitator if you no longer plan to attend the group.

  • Referral to Alternative Resources

If the group facilitator determine that group telehealth services are inadequate for the situation and your needs, we reserve the right to either connect you to our individual counseling services or provide you a list of services available in your community.

  •  Request for Feedback

In order to maintain high quality group telehealth services, we may ask you to complete an anonymous evaluation of the group you attended. While your completion of this evaluation is voluntary, your input would be greatly appreciated

Your Responsibilities as a Group Participant in Telehealth Services

  1. You must use a secure (non-public) internet connection to participate in the group.
  • Recording of the telehealth group meeting by members is strictly prohibited. It is your responsibility to disable computer and device-generated recording. You may be subject to legal action by group members if you create or share any audio or video recordings of group meetings. Should the facilitator need to record the session for supervision purposes, that person will first obtain the written consent of all participants.
  • In order to maintain the group’s privacy, it is important to connect from a quiet and private room with no interruptions or distractions from people or other devices. It is imperative that no persons, other than yourself, are in hearing or visual proximity to you during the group meeting.
  • Although guarantees cannot be provided by the group facilitator(s), group members must agree to maintain the confidentiality of other group members. This means that you may not disclose names or other identifying information about group members, nor may you discuss the personal issues and experiences of other members. This includes, but is not limited to, written posts and pictures on social media forums. Discussing your own experience of being in the group with non-members is acceptable.
  • It is important that group members arrive on time for the group meeting to minimize disruptions. If you are signed up for a support group please notify us by either calling the office or emailing the group leader at least twenty-four (24) hours in advance if you cannot attend.

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384 Crystal Run Road,
Suite 201
Middletown, NY 10941

(845) 692-8780

200 Westage Business
Center Drive,Suite 119
Fishkill, NY 12524

(845) 896-0610

Airmont Professional Center
156 Route 59, Suite A2
Suffern, NY 10901

(845) 517-2870

5 Hudson Valley Professional Plaza
Newburgh, NY 12550

(845) 692-8780