2020 COVID19 Response

 

Your physical and emotional health is our greatest focus. Based on public health recommendations of social distancing, my practice will be including telehealth and  phone sessions immediately to ensure you continue to have access to care, and that you don’t have to be concerned about possible exposure in my waiting rooms or offices. I am taking the utmost care. I can call you to talk over logistics re video conferencing. You will need to find a quiet place that is private so that they can share freely, as best to their ability. Here is a link to what to expect of a virtual session and how to prepare.

I am concerned about you. Our therapy appointments are important to both of us, but we can’t have them in person while you are sick. I can’t be here for you if I get sick, and I have to try to ensure that your fellow clients can come here without getting sick. If you are sick or if you’ve been exposed to anyone with the virus, been in an airport, or showing any symptoms of ANY illness including a fever, please wait 14 days after the fever has subsided before coming in for an in-person appointment. We can convert your appointment to a telehealth appointment. See this quick article on what a telemedicine session might be like: https://www.apa.org/helpcenter/online-therapy or    https://theranest.com/blog/starting-telehealth/

Regarding confidentiality in the current crisis, if you test positive and the CDC asks you for names of people who you’ve been in contact with in order to stop the spread of the virus- you (and I) will need to provide that information. “The Privacy Rule expressly permits disclosures without individual authorization to public health authorities authorized by law to collect or receive the information for the purpose of preventing or controlling disease, injury, or disability, including but not limited to public health surveillance, investigation, and intervention.” Here is in depth information on HIPAA and privacy as it pertains to the CDC and stopping the spread of disease: https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm

Videoconferencing psychotherapy sessions are provided on my HIPAA-compliant Zoom platform. This platform allows for real-time video communication. You do not need your own Zoom account to join me in my “Zoom room.” However, you will need a computer with a video-camera. A day or so before the meeting, I will send you a Zoom link. At the time of the meeting, click on the link. A video screen will pop up. You may have to click on icons in the lower left corner of the video box to turn on your microphone and camera.

Limitations Due to Use of this Technology

A variety of technological problems can cause delays in starting meetings or can interrupt a meeting. If case we lose our connection, please call my home office desk a 985-893-1248: Please provide the phone number that I can call in case our internet connection fails: __YOUR NUMBER__________. Keep this phone with you while we meet so that I may call you as needed. If we cannot successfully reconnect on the internet, we can reschedule or continue on the telephone.

The audibility of videoconferencing is usually not as good as in face-to-face meetings. My experience is that participants often need to ask each other to repeat what we each said. We will also be less able to observe each other’s’ body language. All of this can result in a less “felt” sense of each other as compared to meeting face-to-face. If you sense that I have missed your meaning or responded in an unhelpful way, please tell me as soon as possible so that we can work to repair the mis-communication or mis-step.

Confidentiality Caveats

Communication via the internet cannot be guaranteed to be 100% secure. The following are steps that we can take to increase security and confidentiality.

  1. The Zoom videoconferencing platform and its Epic software are HIPAA-compliant. Our meetings are encrypted with AES-256 bit encryption and dynamic password protected. You can read more about Zoom security here:

https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsupport.zoom.us%2Fhc%2Fen-us%2Farticles%2F115002222603-Epic-Integration&data=02%7C01%7Ccmiles%40TULANE.EDU%7C95c6f65ccb8542594f3908d7ca27b998%7C9de9818325d94b139fc34de5489c1f3b%7C0%7C0%7C637200144320546371&sdata=4JAK5YHuOUoztWx0Xl%2Bpg7TrTnj5Nw9JzgwAlYncihg%3D&reserved=0

  1. We both agree not to record our videoconference meetings.
  2. To prevent non-participants from joining our confidential meetings electronically, we must both secure the links to our Zoom meetings that I send to you via email. Ensure your email account and mobile device have secure passwords and ensure that you close your email platforms when not in use. I will do the same.
  3. We both agree not to have any other people in the rooms where we hold our video-conference.
  4. In my experience, interruptions at home tend to occur during videoconferencing sessions and we should anticipate these. We can limit interruptions by telling people in our homes that we are having a confidential meeting, closing the doors to our rooms, and by placing a “Do Not Disturb” sign on our doors. Nonetheless, people may forget and walk in, other phone lines and doorbells ring, pets make their presence known, etc.

 

Payment for Sessions

Clients paying out-of-pocket for therapy will pay the same fee as when we meet in person. For clients using health insurance, I will seek authorization for insurance payment for video-conferencing therapy. Co-payments will still apply. If the insurance company will not authorize this service, we will make other arrangements.

Payment should be made by check by mail to my home address during the current health crisis:

I also have a establish a PayPal account for this purpose under my cmileslcsw@icloud.com  email address.

 

Cancellations

Given the demands of the current health crisis, there may be a need for last-minute cancellations and we will need to be flexible with each other. Nonetheless, we must respect the time we each commit to our meetings.

Agreement

I have read the above information on videoconferencing psychotherapy, the limitations, and confidentiality caveats. With this understanding, I wish to participate in videoconferencing psychotherapy sessions when health or other concerns prohibit our being able to meet in person.

 

Some info on etiquette online

Find a quiet area, free from things that may distract others (pets, people, television, phone, doorbell) Even though you can have online meetings from basically anywhere, it’s best to choose somewhere quiet where there won’t be a lot of distractions or noise.

  • Do not drive or complete other tasks while you’re in the meeting — this is dangerous
  • Treat a live session as though you were in a physical meeting. Always connect via video – and leave it on for the duration of your meeting – (only turn off video when absolutely needed, the same way you would step out of physical meeting).
  • Be sure to connect in a location that has strong internet connectivity
  • Make sure your face can be seen on the camera and be aware of what is in the background so there are no distractions for your therapist.
  • Dress appropriately
  • To avoid background noises becoming a distraction for others, simply mute yourself when you’re not speaking for a fair amount of time.
  • Listen carefully show that you’re listening

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For the period of the current crises, would you like to call or video conference me? If so, please review the attached consent form for Telehealth Services, sign and return a copy to me.

 

 

 

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Informed Consent for Telehealth Services

 

Definition of Telehealth: Telehealth involves the use of electronic communications to enable clinicians to connect with individuals using live interactive video and audio communications. Telehealth includes the practice of psychological health care delivery, diagnosis, consultation, treatment, and referral to resources, education, and the transfer of medical and clinical data.

 

I understand that I have the rights with respect to telehealth:

 

  1. The laws that protect the confidentiality of my personal information that I have already signed also apply to telehealth. Copy of my Office Policies and Therapeutic Informed Consent can be provided.
  2. I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment.
  3. I understand that there are risks and consequences from telehealth, including, but not limited to, the possibility, despite reasonable efforts on the part of the therapist, that: the transmission of my personal information could be disrupted or distorted by technical failures, the transmission of my personal information could be interrupted by unauthorized persons, and/or the electronic storage of my personal information could be unintentionally lost or accessed by unauthorized persons. I utilize secure, encrypted HIPAA compliant audio/video transmission software to deliver telehealth via securevideo.com
  4. By signing this document, I agree that certain situations, including emergencies and crises, are inappropriate for audio-/video-/computer-based psychotherapy services. If I am in crisis or in an emergency, I should immediately call 9-1-1 or seek help from a hospital or crisis-oriented health care facility in my immediate area.

 

Payment for Telehealth Services:

You may pay by credit card via PayPal services prior to session during this crisis. To make a payment through PayPal, however, you will need to set up an account with PayPal to be able to do so. You may send a check or money order to 110 East 7th Ave, Covington, LA 70433.

 

Carol Miles MSW, LCSW LLC will bill insurance for telehealth services when these services have been determined to be covered by an individual’s insurance plan.  Currently the only insurance companies I have agreed to bill are allowing telemedicine in light of the current emergency circumstances. The standard copay and/or deductibles would apply. In the event that insurance does not cover telehealth, you may wish to pay out-of-pocket, or when there is no insurance coverage. I can provide you with a statement of service to submit to your insurance company.

 

 

Patient Consent to the Use of Telehealth:

I have read and understand the information provided above regarding telehealth, have discussed it with my therapist, and all of my questions have been answered to my satisfaction. I have read this document carefully and understand the risks and benefits related to the use of telehealth services and have had my questions regarding the procedure explained.

I hereby give my informed consent to participate in the use of telehealth services for treatment under the terms described herein. By my signature below, I hereby state that I have read, understood, and agree to the terms of this document.

Print Name/phone number _____________________________________________

Client’s Signature/Date ________________________________________________

Therapist Name _________________________________________________________

Therapist’s Signature/Date _____________________________________________

110 East 7th Avenue

Covington, La 70433

phone 985.893.1248

cmiles@tulane.edu

www.carolmiles.com

 

Videoconferencing psychotherapy sessions are provided on my HIPAA-compliant Zoom platform. This platform allows for real-time video communication. You do not need your own Zoom account to join me in my “Zoom room.” However, you will need a computer with a video-camera. A day or so before the meeting, I will send you a Zoom link. At the time of the meeting, click on the link. A video screen will pop up. You may have to click on icons in the lower left corner of the video box to turn on your microphone and camera.

 

Limitations Due to Use of this Technology

 

A variety of technological problems can cause delays in starting meetings or can interrupt a meeting. If case we lose our connection, please call my home office desk at: Please provide the phone number that I can call in case our internet connection fails: ______________. Keep this phone with you while we meet so that I may call you as needed. If we cannot successfully reconnect on the internet, we can reschedule or continue on the telephone.

 

The audibility of videoconferencing is usually not as good as in face-to-face meetings. My experience is that participants often need to ask each other to repeat what we each said. We will also be less able to observe each others’ body language. All of this can result in a less “felt” sense of each other as compared to meeting face-to-face. If you sense that I have missed your meaning or responded in an unhelpful way, please tell me as soon as possible so that we can work to repair the mis-communication or mis-step.

 

Confidentiality Caveats

 

Communication via the internet cannot be guaranteed to be 100% secure. The following are steps that we can take to increase security and confidentiality.

 

  1. The Zoom videoconferencing platform and its Epic software are HIPAA-compliant. Our meetings are  encrypted with AES-256 bit encryption and dynamic password protected. You can read more about Zoom security here:

https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsupport.zoom.us%2Fhc%2Fen-us%2Farticles%2F115002222603-Epic-Integration&data=02%7C01%7Ccmiles%40TULANE.EDU%7C95c6f65ccb8542594f3908d7ca27b998%7C9de9818325d94b139fc34de5489c1f3b%7C0%7C0%7C637200144320546371&sdata=4JAK5YHuOUoztWx0Xl%2Bpg7TrTnj5Nw9JzgwAlYncihg%3D&reserved=0

 

  1. We both agree not to record our videoconference meetings.

 

  1. To prevent non-participants from joining our confidential meetings electronically, we must both secure the links to our Zoom meetings that I send to you via email. Ensure your email account and mobile device have secure passwords and ensure that you close your email platforms when not in use. I will do the same.

 

  1. We both agree not to have any other people in the rooms where we hold our video-conference.

 

  1. In my experience, interruptions at home tend to occur during videoconferencing sessions and we should anticipate these. We can limit interruptions by telling people in our homes that we are having a confidential meeting, closing the doors to our rooms, and by placing a “Do Not Disturb” sign on our doors. Nonetheless, people may forget and walk in, other phone lines and doorbells ring, pets make their presence known, etc.

 

Payment for Sessions

 

Clients paying out-of-pocket for therapy will pay the same fee as when we meet in person. For clients using health insurance, I will seek authorization for insurance payment for video-conferencing therapy. Co-payments will still apply. If the insurance company will not authorize this service, we will make other arrangements.  Payment should be made by check by mail to my home address during the current health crisis:

 

I will also establish a Paypal account for this purpose and will notify you once it is ready.

 

Cancellations

 

Given the demands of the current health crisis, there may be a need for last-minute cancellations and we will need to be flexible with each other. Nonetheless, we must respect the time we each commit to our meetings. I will apply a $40 cancellation fee for non-urgent cancellations without 24 hours notice.

 

Agreement

 

I have read the above information on videoconferencing psychotherapy, the limitations, and confidentiality caveats. With this understanding, I wish to participate in videoconferencing psychotherapy sessions when health or other concerns prohibit our being able to meet in person.