Consent for Telepsychiatry Services

Dr. Clayton S. Hall, D.O. & Associates, LLC
3229 Summit Square Place
Suite 200
Lexington, Ky 40509

What is Telepsychiatry?

Telemedicine is the process of providing health care from a distance through technology, often using videoconferencing. Telepsychiatry, a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.

Telepsychiatry can involve direct interaction between a psychiatrist and the patient. It also encompasses psychiatrists supporting primary care providers with mental health care consultation and expertise. Mental health care can be delivered in a live, interactive communication. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review.

Benefits of Telepsychiatry

Video-based telepsychiatry helps meet patients’ needs for convenient, affordable and readily accessible mental health services. It can benefit patients in a number of ways, such as:

  • Improve access to mental health specialty care that might not otherwise be available (e.g., in rural areas);
  • Bring care to the patient’s location;
  • Help integrate behavioral health care and primary care, leading to better outcomes;
  • Reduce the need for trips to the emergency room;
  • Reduce delays in care;
  • Improve continuity of care and follow-up;
  • Reduce the need for time off work, childcare services, etc. to access appointments far away;
  • Reduce potential transportation barriers, such as lack of transportation or the need for long drives; and
  • Reduce the barrier of stigma.

While some people may be reluctant or feel awkward talking to person in a screen, experience shows most people are comfortable with it. Some people may be more relaxed and willing to open up from the comfort of their home or a convenient local facility. Also, this will likely be less of a problem as people become more familiar and comfortable with video communication in everyday life.

Telepsychiatry allows psychiatrists to treat more patients in distant locations. Psychiatrists and other clinicians need to be licensed in the state(s) where the patient they are working with is located. State licensing boards and legislatures view the location of the patient as the place where “the practice of medicine” occurs.

Although telepsychiatry has the disadvantage of the patient and psychiatrist not being in the same room, it can create enhanced feelings of safety, security and privacy for many patients.

Evidence for Effectiveness

There is substantial evidence of the effectiveness of telepsychiatry and research has found satisfaction to be high among patients, psychiatrists and other professionals. Telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care and patient satisfaction. Patient privacy and confidentiality are equivalent to in-person care.

Research has also found that overall experiences among all age groups have been good. There is evidence for children, adolescents and adults regarding assessment and treatment (medication and therapy). There are even people for which telemedicine may be preferable to in-person care, for example people with autism or severe anxiety disorders and patients with physical limitations may find the remote treatment particularly useful.

Telepsychiatry has been found especially effective with respect to the treatment of PTSD, depression, and ADHD.

In SUMMARY, there is robust evidence that shows Telepsychiatry improves patient outcomes and shows high patient satisfaction by meeting patients’ needs for convenient, affordable and readily accessible mental health and substance abuse care.

Reference: American Psychiatry Association, APA

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Risks of Telepsychiatry 

Most common risks are technological and confidentiality issues. Technological risks would include: Improper or unavailable equipment; Equipment malfunctions, including audio and/or visual problems that may affect two-way communication of verbal & non-verbal information. Missed information can lead to errors in judgment by the practitioner. Risk of breeches or “hacking” of patient Protected Health Information (PHI) and HIPAA violations are rare, but possible. Environmental disruptions during Telepsychiatry appointments may decrease privacy. Preparing a quiet, private location in your home or office can minimize privacy risks.

Alternatives to Telepsychiarty

  1. Traditional visit in the Psychiatrist’s office. Tell your psychiatrist if you are dissatisfied or uncomfortable with Telepsychiatry appointments. * New patients must be seen in the office for Initial Evaluations, unless the Psychiatrist deems a situation as a medical emergency and the patient cannot come to the office.
  2. Telephone Appointments. Although telephone technology can be quite effective and has many of the same risks & benefits as Telepsychiatry, the Telephone is NOT considered Telepsychiatry. Audio communication between patient and provider does not include visual information, which is often helpful. However, telephone appointments may be necessary in certain cases: travel barriers or restrictions; lack of Telepsychiatry equipment (phone, personal computer, camera, tablet, internet (WiFi) or lack of a cellular connection.

Patient Rights 

I understand that the laws that protect my privacy and confidentiality of medical information also applies to Telepsychiatry and I can withdraw my consent at any time, inspect all medical information, may obtain copies of my medical record information and may release my medical records to anyone with my written consent. I understand that withholding or withdrawing my consent of Telepsychiatry services will not affect my future care or treatment in the future. I understand that my consent for Telepsychiatry care will remain in force, unless it is revoked by me or my provider.

I understand that I may withhold or withdraw my consent for treatment by writing or contacting the office of Dr. Clayton S. Hall, D.O. & Associates, LLC, at:

3229 Summit Square Place
Suite 200
Lexington, KY 40509

Patient Responsibilities

Please  read this section carefully. We need everyone’s  understanding, cooperation and flexibility!


  1. Call and speak with our Office Manager, Kim, and schedule an appointment. If you already have an appointment, call and verify the exact date and time of your appointment. *** MAKE SURE YOU SCHEDULE YOUR APPOINTMENT AT A TIME AND LOCATION THAT WILL BE PRIVATE AND FREE OF INTERRUPTIONS! We would appreciate payment for services at this time. Kim may gather additional information from you and give instructions about the Telepsychiatry process and answer any questions you may have. 
  1. Dr. Hall or your psychiatric provider will call you and send you a secure, HIPAA-compliant e-mail or text message.
  2. Complete & Submit this Telepsychiatry Consent Form.


  1. Please be available for a phone call 1-hour before and 1-hour after your scheduled appointment time.
  2. Make sure you create a safe, private, distraction-free environment for your appointment. Inform your provider if anyone can see or hear any part of your session. Patients may invite family or supportive persons to their appointments, but all names must be disclosed before the session begins.
  3. If your home environment is not private, we will call you back when you have established a private setting.
  4. Recording of Sessions by audio or video is NOT ALLOWED. This applies to both patient and provider.
  5. If video technology is unavailable or problematic, the provider & patient may use the telephone to complete the session.


  1. Medications. We will call, fax or electronically send your medication prescriptions to your designated Pharmacist, as soon as possible. In some cases, patients may pick up their prescriptions at our office (especially samples) or have your prescriptions mailed to you. In most cases, your Pharmacist will call you when your medications are due. ***Medications can be received only when they are due! Requesting early refills is unacceptable and may be a sign of misuse of medications. Keep medications safe from children, theft or damage.
  2. Call our Office at 859-333-1477 to schedule an appointment. If Kim is busy, she will call you back as soon as possible, hopefully by the end of the workday, so please try to be available. ***Please call our office if you change addresses, phone numbers, pharmacy information, emergency contacts, or any other personal information.
  3. Please be available to return all phone calls to our office in a timely manner. We may need to update your information, give you important information, or request blood work, urine drug screens or pill counts at our office or other designated site

Reasons for Termination of Care

Dr. Clayton S. Hall, D.O. & Associates LLC may terminate patient care for the following reasons:

  • Providing dishonest or misleading information;
  • Not following agreed-upon treatment plans;
  • Excessively missing, rescheduling or arriving late to appointments;
  • Engaging in inappropriate, rude or disruptive behavior;
  • Evidence of abuse, misuse or diversion of illicit or prescription medications;
  • Failure to keep medications safe from children, theft or damage;
  • Frequent requests to call in medications early; and/or
  • Suspected illegal activity such as sharing or selling of medication, or legal charges or convictions during treatment.29 Summit Square Place

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