Telehealth Informed Consent

Clear Path Behavioral Health
A California Professional Medical Corporation — Online Telemedicine Practice

This Telehealth Informed Consent (“Consent”) describes the nature of the telehealth services provided by Clear Path Behavioral Health (“Practice,” “we,” “us,” or “our”), an online-only telemedicine practice, along with the benefits and risks of receiving care through telehealth and your rights as a patient. This page is provided for your information before you begin care. A separate consent form, specific to your treatment, will be reviewed and signed as part of your intake process; this website disclosure does not itself constitute your signed consent to treatment.

1. Nature of Telehealth Services

Telehealth (also called telemedicine or telepsychiatry) is the delivery of healthcare services using audio, video, or other electronic communication technology, where the provider and patient are not in the same physical location. Clear Path Behavioral Health provides psychiatric evaluation, medication management, and related behavioral health services exclusively via telehealth. We do not maintain a physical clinic location for patient visits.

Clear Path Behavioral Health is currently licensed to provide services to patients located in California.

Telehealth is not a replacement for in-person emergency care. It is one method of delivering care, and it may not be appropriate for every patient or every clinical situation, as determined by your provider.

2. Potential Benefits

• Increased access to psychiatric and behavioral health care, particularly for patients who face distance, mobility, transportation, or scheduling barriers.
• Reduced travel time and associated costs.
• Ability to receive care in a familiar, private setting.

3. Potential Risks and Limitations

Telehealth has risks and limitations that differ from in-person care, including but not limited to:

• Technical failures: video or audio may freeze, disconnect, or degrade in quality, which could interrupt or delay your session.
• Limitations on physical examination: your provider cannot conduct a hands-on physical examination and may have a more limited ability to observe non-verbal cues, vital signs, or physical symptoms than in an in-person visit.
• Privacy of your physical environment: your provider cannot control or guarantee the privacy of the location from which you connect. You are responsible for choosing a private, confidential setting for your appointment.
• Security risks inherent to electronic transmission of health information, notwithstanding the safeguards described in Section 5.
• The possibility that your provider may determine, at any point, that your condition requires in-person evaluation, and may decline to continue treatment by telehealth alone.

4. Your Rights and Alternatives

• You have the right to withhold or withdraw your consent to telehealth at any time, without affecting your right to future care or treatment.
• Clear Path Behavioral Health is an online-only practice and does not offer in-person visits. If your provider determines that your condition requires in-person evaluation or a level of care we do not provide by telehealth, your provider will refer you to an appropriate in-person or higher level of care resource; the Practice does not itself provide an in-person alternative.
• You have the right to ask questions about the equipment, technology, and process used in your telehealth visit before your appointment.
• You retain all other rights described in our Notice of Privacy Practices.

5. Confidentiality and Privacy

Your health information is protected under the Health Insurance Portability and Accountability Act (“HIPAA”) to the same extent as information shared during an in-person visit. Telehealth sessions are not recorded by the Practice unless you are separately notified and asked for consent (see Section 8).

California law: Under the California Confidentiality of Medical Information Act (Civil Code § 56.10 et seq., including § 56.104 governing psychotherapy notes), your mental health treatment information receives additional protection beyond HIPAA and generally will not be disclosed without your written authorization, except as permitted by law (for example, to coordinate your treatment, in response to a valid subpoena or court order, or to avert a serious and imminent threat to health or safety).

We use Zoom to conduct visits, which is configured to support HIPAA compliance through a signed Business Associate Agreement. No electronic communication system is completely secure; unauthorized third parties could theoretically gain access despite reasonable safeguards.

Privacy Officer: Joe Nascimento, 925 N La Brea Ave., Suite 570, Los Angeles, CA 90038; 310-388-6394

6. Emergency Procedures and Limitations

Telehealth is not appropriate for medical or psychiatric emergencies.

If you are experiencing a medical emergency, thoughts of harming yourself or others, or any other crisis, do not wait for a scheduled telehealth appointment. Call 911, go to the nearest emergency room, or call or text 988 (Suicide & Crisis Lifeline).

At the start of each telehealth visit, your provider will confirm your physical location and identify the nearest emergency facility to you, in case of a disconnection or an emergency during the session.

7. Controlled Substance Prescribing via Telehealth

Certain medications prescribed by our providers are controlled substances under federal and California law. Federal law governing remote prescribing of controlled substances without a prior in-person examination has been subject to a series of temporary flexibilities and extensions since 2020, and the applicable federal framework may change.

Your provider will explain any applicable requirements (such as periodic in-person or additional evaluation) that apply to your specific treatment.

8. Recording

Telehealth sessions are not recorded by the Practice as a matter of routine practice. If recording is ever proposed for a specific clinical or educational purpose, you will be asked for separate, specific written consent in advance, and you may decline without affecting your care. You are asked not to record sessions yourself without the mutual agreement of your provider.

9. Financial Responsibility

Telehealth visits are billed in the same manner as in-person visits. Coverage and cost-sharing for telehealth services vary by insurance plan; the Practice does not guarantee coverage or a specific reimbursement rate. You are responsible for verifying your own telehealth benefits with your insurer.

10. Your Formal Consent

This page is provided so you can review our telehealth practices before your first appointment. It is informational and does not by itself constitute your consent to treatment. Before your first visit, you will be asked to review and sign a separate, patient-specific Telehealth Informed Consent form as part of your intake paperwork, which will document your acknowledgment and consent in your medical record.

If you have questions about telehealth before scheduling an appointment, contact us at info@clearpathmind.com or 310-388-6394.