Online/Phone/Telepsychology Therapy Consent
Telepsychology what this means to you
During this COVID -19 pandemic, the Australian Federal Government has allowed for the next six (6) months for psychological services to be held online via Telepsychology. Therefore, you will be able to have a session via video (on your computer, iPad, tablet or smart phone) or via audio on your telephone. This is a temporary service.
This form is in addition to the standard consent form you signed upon your first session with Tamara. It does not replace that document.
I understand that I have the following rights with respect to telepsychology:
I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment
I understand that telepsychology includes consultation, treatment, telephone conversations and education using interactive audio, video or other data communications.
I understand that telepsychology also involves the communication of my medical/mental wellness information both verbally and visually.
I understand I can take written notes during my session with Tamara.
I understand that Tamara does not record telepsychology sessions.
I understand that that I cannot audio or video record my sessions with Tamara.
I understand that I am responsible for any additional costs associated with my own data usage (see 'technical aspects and requirements' for more details).
I understand that I have the following rights with respect to online/telepsychology:
Technical Aspects and Requirements
I understand that there are some potential problems that might arise in the course of accessing online/telepsychology, including, but not limited to, the possibility, despite reasonable efforts on the part of Tamara Cavenett, that the transmission of my information could be disrupted or distorted by technical failures. I understand that if the online/telepsychology session does get disconnected, or runs poorly, Tamara Cavenett will contact me via phone to continue our session.
I understand that I am responsible for (a) providing the necessary computer, data telecommunications equipment and internet access for my online/telepsychology sessions, (b) using Zoom, and (c) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for my online/telepsychology session. Tamara Cavenett will advise if any therapy materials may be required for the session.
I understand that I am responsible for all personal internet data usage costs. Tamara Cavenett accepts no responsibility for personal internet data usage costs. If you are meeting over a cellular network (For example 3G, 4G etc.), telepsychology will use a considerable amount of your data. Similar data use will occur by wifi.
As part of providing a psychological service to you, Tamara Cavenett will need to collect and record personal information that is relevant to your current situation. This information will be a necessary part of the psychological assessment and treatment that is conducted. The information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service. This information may be viewed by administration staff in order for the service to be provided to you. You do not have to give all your personal information, but if you do not provide relevant information, this may mean the psychological service may not be able to be provided to you. Use of practice management software may result in data being transferred and stored using online platforms "data cloud", or an offsite third-party server. At any stage, you may have access to the information about you kept on file, unless the relevant legislation provides otherwise. The psychologist may discuss the contents with you and/ or discuss appropriate forms of access. Your case note records may be confidentially destroyed after a period of (7) years following cessation of treatment.
The information shared with a psychologist remains confidential, with the following exceptions:
Acute Crisis - Risk of Harm to Self or Others
If a wish to commit suicide is indicated, or a client is assessed as being a risk to themselves and/or others the psychologist will contact the Statewide Mental Health Triage, if the person is present. If the client is not present (i.e. has contacted the psychologist by phone/telepsychology) the psychologist will immediately call the Police and advise them whether or not Statewide Mental Health Triage have been contacted as yet and if not, the Police will do so.
Obligation to Report Child Abuse
Pursuant to Section 11 of the Children's Protection Act 1993, the psychologist must notify Families SA if they suspect that a child has been or is being abused or neglected.
Possession of a firearm
If a client of the psychologist is suffering from a physical or mental illness, disability or deficiency that is likely to make the possession of a firearm by the person unsafe for the person or any other person; and that person holds or intends to apply for a firearms license or possesses or has the intention of possessing a firearm; the psychologist has a duty to inform the Registrar of Firearms in writing of the person’s name and address, the nature of the illness, disability or deficiency and the reason why in the opinion of the psychologist it is or would be unsafe for the person to have possession of a firearm.
GP Mental Health Care Plan/Psychiatrist Referral Under the Medicare Better Access Scheme
Under the Medicare Benefits Schedule, the psychologist is required to provide a written report to the referring doctor at the completion of the first set of six sessions and before the review of the need for a further set of four services is conducted by your doctor. A written report must also be provided to the referring doctor at the completion of the second set of four services, and regularly as clinically relevant. The psychologist's reports to the referring doctor will become part of your medical record at the medical practice. The psychologist may also contact and update the referring doctor at any time deemed relevant by the psychologist.
With prior approval
If a client has given approval, the psychologist may provide a written report to another professional or agency, e.g. a GP or a lawyer; or discuss the material with another person, e.g. a parent or employer.
It is subpoenaed by court
Telepsychology and confidentiality
The laws that protect the confidentiality of my medical information also apply to online/telepsychology. As such, you understand that the information disclosed by yourself during the course of your therapy is confidential when accessed via our secure platform Zoom. Zoom is HIPAA compliant and does not store any patient data unless instructed by the psychologist and even in that case it is encrypted so only your psychologist has access to it.
However, despite best efforts the privacy of any form of communication via the internt or a mobile device is potentially vulnerable and limited by the security of the technology.
Further information on patient privacy and security can be access by visiting this link.
Email and confidentiality
The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology. Please be aware that email communications are not secure and should contain minimal personal information.
SMS Reminder Service
Tamara Cavenett offers a SMS reminder service the day before each appointment where you will receive a reminder of your scheduled appointment for the following day. This message is not a confirmation of attendance and you will still be required to contact Tamara Cavenett if you can no longer make your appointment. An appointment scheduled with Tamara Cavenett will still occur even if for some reason you do not receive the reminder SMS message.
If you do not agree to receiving a SMS reminder please advise Tamara Cavenett immediately by contacting 08 82698188 or using our contact form
If, for some reason, you need to cancel or postpone the appointment, please provide at least 24 hours’ notice from the scheduled time of your appointment otherwise a $200 non-attendance fee will apply. If you do not attend on two or more scheduled occasions then it will be assumed that you no longer require the service and no further sessions will be booked. Cancellation fees do not attract a rebate from Medicare/private Health or WorkCover. Sessions will not be billed to Medicare/WorkCover if you do not attend.
Should you fail to give 24 hours’ notice when cancelling your scheduled appointment you agree to pay Tamara Cavenett the $200 non-attendance fee. If, at any time, this account is not paid within 14 days and the matter has to be referred to a debt collection agency, you agree to pay all out of pocket expenses and commissions.
I accept that online/telepsychology does not provide emergency services. If I am experiencing an emergency situation, I understand that I can call 000; or proceed to the nearest hospital emergency room for help; or call my primary care GP or psychiatrist. If I am having suicidal thoughts or making plans to harm myself, I can call Lifeline on 13 11 14 for free 24 hour hotline support or the anonymous Suicide Help Line on 1300 651 251, the Statewide Mental Health Triage on 13 14 65 or Kids Helpline on 1800 551 800.
Please Note: If, after reading this page, you are at all unsure of what is written, please discuss it with Tamara Cavenett.
If you continue with the telepsychology session it is assumed you agree with, and fully understand of the above information and that you have been given the opportunity to discuss these issues and ask any questions.