Transcription of PATHWAYS INSTITUTE Pathways Institute …
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PATHWAYS INSTITUTE Pathways Institute …
PATHWAYS INSTITUTE5758 Geary Blvd. #227, San Francisco, CA 94121 | | INSTITUTE telemedicine informed ConsentI hereby consent to engaging in telemedicine as part of my psychotherapy. I understandthat telemedicine includes the practice of health care delivery, diagnosis, consultation,treatment, transfer of medical data, and education using interactive audio, video, or datacommunications. I understand that telemedicine also involves the communication of mymedical/mental information, both orally and visually, to health care practitioners located inCalifornia or outside of understand that I have the following rights with respect to telemedicine :(1) I have the right to withhold or withdraw consent at any time without affecting my right tofuture care or treatment nor risking the loss or withdrawal of any program benefits to which Iwould otherwise be entitled.
PATHWAYS INSTITUTE 5758 Geary Blvd. #227, San Francisco, CA 94121 | www.pathwaysinstitute.net | 415.267.6916 Pathways Institute Telemedicine Informed Consent
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