Electronic Communication Consent Form for BHRS
This form is essential for clients of San Mateo County Behavioral Health and Recovery Services. It outlines the use of electronic communication for client-provider interactions. Understanding this form helps ensure a secure, informed, and effective treatment process.
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How do I fill this out?
To fill out this form, start by entering your client information at the top. Ensure you understand the electronic communication options available before signing. Finally, review your consent choices for communication methods before submission.
How to fill out the Electronic Communication Consent Form for BHRS?
1
Fill in your personal details at the beginning.
2
Read the instructions regarding electronic communication.
3
Select your preferred communication methods by checking the applicable boxes.
4
Sign and date the form to confirm your consent.
5
Submit the completed form following the provided submission instructions.
Who needs the Electronic Communication Consent Form for BHRS?
1
Clients seeking mental health services need this form to establish communication preferences.
2
Individuals who prefer telehealth must complete this form to consent to virtual appointments.
3
New clients enrolling in BHRS programs need this for electronic communication consent.
4
Patients with transportation barriers may use this form for telehealth services.
5
Anyone wanting to utilize secure messaging for communication with their provider requires this form.
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Make the necessary changes and adjustments.
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What are the instructions for submitting this form?
To submit the form, please return it to your BHRS provider via email at bhrs@smchealth.org or fax it to (650) 372-6061. You may also drop it off in person at your local BHRS office. Make sure to keep a copy for your records.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates associated with this form; it is valid as long as you are receiving services from BHRS.
What is the purpose of this form?
The purpose of this form is to ensure clients of BHRS understand their options for electronic communication. By completing this form, clients can express their consent for telehealth services and secure messaging. It also outlines important details regarding the potential risks and benefits associated with electronic communication.
Tell me about this form and its components and fields line-by-line.
- 1. Client Name: The full name of the client.
- 2. MR#: The medical record number of the client.
- 3. Provider: The name of the healthcare provider.
- 4. DOB: The date of birth of the client.
- 5. Program: The specific program the client is enrolled in.
What happens if I fail to submit this form?
If the form is not submitted, clients may face interruptions to their communication preferences with their provider. This may delay important electronic communication necessary for their care. Clients will be unable to utilize telehealth services without proper consent.
- Delayed Communication: Clients may not receive timely updates about their appointments or treatment.
- Access to Telehealth: Lack of consent could prevent clients from accessing telehealth options.
- Missed Opportunities: Important information may not be conveyed efficiently without consent.
How do I know when to use this form?
- 1. Consenting to Telehealth: This form is used to give consent for telehealth services.
- 2. Establishing Communication Preferences: It's vital for clients to outline their preferences for communication.
- 3. Securing Information Transmission: Clients ensure that their confidential information is communicated securely.
Frequently Asked Questions
What is this electronic communication consent form?
This form allows clients to consent to electronic communication with their BHRS provider.
How do I fill out this form?
Simply enter your details, review the options, select your preferences, and sign it.
Can I edit this PDF on PrintFriendly?
Yes, you can easily edit the document before downloading it.
What benefits does telehealth offer?
Telehealth increases access to care and reduces travel, making it easier for clients.
How do I submit this form?
Follow the submission instructions provided at the end of the form.
Are my communications secure?
BHRS uses HIPAA-compliant platforms to ensure secure communication.
What types of communication can I consent to?
You can consent to phone calls, emails, and telehealth services.
Is there a risk in electronic communication?
Yes, there are risks, but steps are taken to minimize them.
What happens if I don’t submit this form?
Your electronic communication preferences may not be established.
Can I withdraw my consent later?
Yes, you can withdraw consent at any time without affecting future care.
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