Consent to Telehealth PATIEN CONSENT TO TELEHEALTH Due to SARS-CoV-2 ( also know as COVID-19) Pandemic, CarrouselTherapy Center is working very hard to get as many patients in Telehealth as possible. * There are some conditions that may delay or prevent Carrousel Therapy Center from connecting to the patient, One of them is the connection being used by the person/patient/client. These are also conditions or considerations: 1. Children (minors 17 or less as State Law requieres) must de with the Caregiver/Parent. 2. HIPAA Compliance connections- Protect your Pii (private identifying information) and HOI ( health protect information). 3. You can not be in public places and no persons around the patient/client 4. The Law included in Telehealth: Allows be compliant both sides: the Doctor and the Patient. 5. We cannot do Telehealth thru WhatsApp or Facebook face-to-face. 6. We cannot do Telehealth if you are inside a car in movement (driving, Uber, Taxi) 7. Patient/Client of family member cannot be recording, or be behind the camera. 8. Most Important: You or Your caregiver must Consent to Telehealth by filling the following form: Patient/Client Consent * I,adult and responsible for myself. Attest that I accept the Terms and Conditions to this Telehealth visit. Patient/Client Signature * signature keyboard Clear Date * Parent/Legal Guardian Consent I,adult and responsible for myself. Attest that I accept as the Parent/Legal Guardian, the Terms and Conditions to this Telehealth visit. Parent/Legal Guardian Signature signature keyboard Clear Date Please understand that if there is a delay, it might be due to several conditions we cannot anticipate. If you are human, leave this field blank. Submit