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Copied from Talkspace’s site:
If you are in a life threatening situation of
experiencing a medical emergency, you should
dial 911 or 988 and/or use these resources for
immediate help.
Informed Consent
By creating a Talkspace account by clicking “Create
account”, you confirm you are 13 years of age
or older, have reviewed the risks and consent
to treatment using the Talkspace platform.
Telehealth services involve the delivery of mental
health services using electronic communications
between a Provider and you, who are not in the
same physical location.
The purpose of this consent is to provide you
with the potential risks and limitations of receiving
treatment through telehealth and to obtain your
informed consent to receive healthcare services
from Talkspace providers or prescribers using
the Talkspace platform. This consent for treatment
continues throughout the course of your treatment
by any Provider on the Talkspace platform.
If you have questions about the consent please
reach out to
<a href="mailto:privacy@talkspace.com">privacy@talkspace.com</a>.
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I understand that the Services include, but
are not limited to, consultation and treatment
using audio, video, written, and/or data
communications.
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I understand that my communication with a
Provider using audio, video, written, and/or
data communications, including communication
of my medical and mental health information,
is recorded in a transcript in my medical
record documentation that is used to support
my Provider’s evaluation and treatment plan.
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I understand that if I have signed up for
Talkspace therapy services, if I want a "real
time" video, audio, or chat session or instant
message style discussion with my therapist,
I will need to schedule it. Otherwise, my
therapist and I will communicate through
messaging not as instant messages or in real
time.
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I understand that my Provider will assess
if telehealth services are right for me and
may not be able to provide certain services
to me. My Provider, in their clinical judgment,
may recommend additional or alternative services,
and may also refer me to another provider
or type of care, such as seeing a medical
doctor for further evaluation and treatment.
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I understand and acknowledge I have the right
to withdraw my consent to Services at any
time without affecting my right to future
care or treatment by Talkspace and its Providers,
nor risk the loss or withdrawal of any health
benefits to which I would otherwise be entitled.
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I understand that the records concerning
any Services I receive from Talkspace may
be shared with my reported Primary Care Physician
(“PCP”). I understand I may notify Talkspace
via email to privacy@talkspace.com, at any
time, that I withdraw consent to share this
information with my PCP.
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I understand and acknowledge the location
of my Services is the state where my Provider
is licensed and physically located, even
when I am communicating with my Provider
by digital or text message platforms.
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I understand that I will be asked to provide
“Emergency Contact Information” (name and
telephone number) for your personal contact
and/or a close family member/relation to
your Provider to be used in case of a mental
health crisis or other emergency where knowledge
of your location is crucial and you agree
to obtain their consent before providing
their Contact Information to your Therapist.
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I understand that it is not recommended that
I suddenly stop contacting my provider or
"drop out" without talking to my provider
about the termination of my treatment. Providers
and clients talk about the expected length
of treatment and ending the provider-client
relationship.
Potential Risks
By participating in the Services, I understand
there are potential risks with this or any treatment.
These risks include, but may include limitations
on providing services through telehealth, confidentiality
and data privacy/protection.
Telehealth Limitations
I understand that telehealth may limit my Provider(s)
from identifying the need for emergency medical
care or treatment for you due to lack of in-person
treatment and that the use of technology may
impact my Provider(s) ability to correctly diagnose
or treat me.
Confidentiality
I understand that the laws that protect privacy
and the confidentiality of healthcare information,
including HIPAA, apply to telehealth services.
I understand that there may be times when my
provider must or should report my healthcare
information to others for safety or legal reasons.
Data Privacy and Protection
I understand that the electronic systems used
in telehealth include features to protect the
privacy and security of my healthcare information,
and will include protections against intentional
or unintentional breaches. I understand that
these protections could fail, causing a breach
of privacy of my medical or other information.
I understand that personal information that identifies
me or contains protected health information will
not be shared to any third party without my consent,
except as authorized by law for the purposes
of treatment, payment/billing, and certain administrative
activities as a part of healthcare operations,
or as otherwise described in Talkspace’s Notice
of Privacy Practices (<a href="https://www.talkspace.com/notice-of-privacy-practices">https://www.talkspace.com/notice-of-privacy-practices</a>).
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emial: Privacy@talkspace.com
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:
Sending a letter: 200 Independence Avenue, S.W., Washington, D.C. 20201
Calling: 1-877-696-6775
or Click Here
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Email: recordrequest@talkspace.com