Introduction and Purpose
Telehealth, also known as telemedicine, involves the use of secure electronic communications, including interactive audio, video, and/or data transmission, to provide healthcare services when distance separates the patient and provider. The purpose of this form is to obtain your informed consent to participate in telehealth-based services with Community Pillars Health and Recovery Centers.
What is Telehealth?
Telehealth allows your provider to:
All electronic systems used by Community Pillars incorporate network and software security protocols to protect your confidentiality and ensure data integrity.
Nature of Services Provided via Telehealth
Benefits of Telehealth
Potential Risks of Telehealth
As with any medical or mental health service, telehealth has potential risks:
If any technical issue disrupts your session, we will work with you to reschedule or follow up as needed.
Confidentiality & HIPAA Compliance
All telehealth services provided by Community Pillars comply with federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). No session will be recorded without your prior written consent. Your personal health information will not be disclosed without your consent unless required by law.
Your Rights as a Patient
Technical Requirements
To engage in telehealth services, you will need:
You will be using Ensora, a HIPAA-compliant telehealth platform. Please ensure that you have downloaded the Ensora app or accessed the Ensora web platform prior to your appointment. If you need help, contact our support team for guidance.
Please inform your provider if you need assistance accessing these resources.
Patient Responsibilities, Safety, and Emergency Protocols
Consent and Acknowledgment
By signing below, I confirm the following:
If you have questions or concerns, please contact our office. We are committed to providing compassionate, high-quality care—whether in person or through telehealth.
