Telehealth Consent: Fill & Download for Free

Saturday night, as I sat in my recliner conveniently located in Canada, where I live, my right eye vision went funny. Black threads infiltrated half my field of vision.Our optometrist’s voicemail said we should go to emergency. But I’m afraid of COVID.We called Telehealth, at no additional charge, to ask a live nurse for advice on how to proceed. The receptionist said we had to wait four+ hours (it turned out to be 7) for a registered nurse to call back.We called the nearest hospital. They said Emerg wasn’t too busy; that I could go in, wait my turn to see the Emerg doctor who would probably give me an Ophthalmology referral appointment in 2–3 days.Meanwhile, I consulted with my optician son. After referring to his texts, he suggested I might have a vitreous detachment (more later).A little research and we found an optometrist (not ours) open Sunday morning that also took emergency walk-ins.Our plan: go to the new optometrist first thing Sunday AM unless the eventual Telehealth call had more urgent instructions.Telehealth did not offer new info.On Sunday morning, the optometrist did see me. She diagnosed a retinal tear and called a hospital’s Ophthalmology department. They said come straight there.My COVID concerns (read: worry) were outweighed by my retinal tear concerns (read: fear).In Sunday afternoon, I wandered into the hospital, satisfied their COVID screener, and took the elevator alone to the eye clinic floor.The hallway was half-lit and people were scarce. In the three hours we were there (my chauffeur wife caught up with me), we saw two staff and seven civilians- including ourselves.The doctor ophthalmologist doctor took a long and thorough look at my eye. Then the retinal Fellow took a look, and confirmed the diagnosis and treatment plan. Having secured my consent, the doctor took me around the corner and lasered my retinal tear into oblivion.Total charge for all services: C$85 for the emergency walk-in at the Optimetrist‘a office.That was my weekend. How was yours?BTW: a vitreous detachment occurs when the vitreous humour (eyeball jelly) shrinks, which is common with age, and pulls away from the retina. In my case, this created a small tear in the retina, and a small bleed. The black threads I could see were blood infiltration.

Absolutely! This happens multiple ways. Consultation liaison psychiatry is psychiatric consultation to other medical specialties (i.e., pulmonology, infectious diseases, and intensive care services) who suspect or recognize a psychiatric disturbance in someone for whom they have primary medical responsibility. They may wear PPE and enter a unit to interview people with active disease. On my “Telehealth Consent” documentation, there is a category called “location of patient.” One option is “Currently hospitalized.” I noticed it without giving it much thought until one of my own patients was hospitalized and reached out to me. I used an app with medical-grade encryption to have brief sessions with her daily while they were in the hospital. You can’t BILL for these sessions, but it is very much in the patient’s interest to have access to his or her own therapist. The attending intensivist consulted with the outpatient psychiatrist, who also held a virtual session with his patient before coordinating on meds with the intensivist. The third way, and we wound up NOT doing it (but were ready to go if needed) is to designate a separate inpatient psychiatric unit just for Covid-19 patients. The staffing is incredibly intense, and very PPE-intensive.

Government bodies expect health care providers will ordinarily conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or another clinic. Providers should always use private locations and patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.If telehealth cannot be provided in a private setting, covered health care providers should continue to implement reasonable HIPAA safeguards to limit incidental uses or disclosures of protected health information (PHI). Such reasonable precautions could include using lowered voices, not using a speakerphone, or recommending that the patient move to a reasonable distance from others when discussing PHI.