Call (916) 450-0700 | ProfessionalTreatmentServices@bridgesinc.net
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.
In an effort to engage and support our clients, Bridges Professional Treatment Services will begin offering Remote Outpatient Treatment on Monday, April 13, 2020.
Remote Client Services will enable you to participate in Treatment with a certified counselor via a virtual meeting platform (“ZOOM”) temporarily during the COVID-19 crisis.
To take advantage of this unique opportunity 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 the payment policy I signed at intake remains valid during this time allowing for billing of services if applicable and/or requirement of payment for services if applicable. 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: