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SECTION 1: PARTICIPANT TELEHEALTH AGREEMENT LETTER
As you are aware, the Novel Coronavirus (COVID-19) has impacted the daily lives of all Californians. The latest direction from the Department of Health Care Services (DHCS) allows for the provision of temporary Remote Client Services also known as Telehealth.
To avoid a delay in completing your DUI Program, Bridges Professional Treatment Services will begin offering Remote Client Services on Monday, March 30, 2020.
Remote Client Services will enable you to continue your DUI classes with a certified counselor via a virtual meeting platform (“ZOOM”) temporarily during the COVID-19 crisis.
To take advantage of this unique opportunity and keep your DUI treatment program on track you must be willing and able to agree to the following Remote Client Services requirements:
By signing here, I certify that I have read, understand and agree to the above-stated terms.
Bridges Professional Treatment Services will provide Remote Client Services (Telehealth) utilizing the “ZOOM” Virtual Meeting Platform. Some personal information such as your name, email address, and computer IP address will be shared with Zoom. Additionally, some meetings may be recorded and uploaded to a cloud for documentation of session completion.
Bridges Professional Treatment Services will continue to maintain confidentiality as stated in our Confidentiality Policy. Clients will also be held to the Confidentiality Agreement signed upon enrollment.
Remote Client Services Release
I understand that fees for DUI Program services will apply during this time, and that Bridges Professional Treatment Services will provide me with a Financial Assessment via telehealth should I request.
SECTION 3: ACCOUNT INFORMATION FOR TELEHEALTH LINKS
Fill in the following required information: