Parkside is proud to offer Telehealth services including assessment for inpatient care, family therapy for inpatients whose families are located at least 60 miles from our campus and outpatient services as individually arranged.TeleHealth offers patients several advantages over traditional, in-office care.
- No wait times – Services are scheduled at absolute times.
- Convenience – Patients can receive high-quality care without long distance travel or being limited to their community mental health clinic. The patient’s family and support system also benefit from local care delivery instead of traveling.
- Cost to patient – The costs for Telehealth visits are similar to traditional office visits and usually covered by medical insurance.
How it works
For a TeleHealth appointment, services are scheduled and a telehealth invitation sent by email along with simple instructions and any necessary forms. Patients can make any necessary co-payments or patient responsibility payments using credit card or paypal and the portal located on this page. Click the link in the invitation and the session can be engaged. They then connect with our provider with the patient via Zoom Telehealth, which provides for encryption and a safe, confidential session. Patients can ask questions and interact, just as they would in a traditional clinic appointment. The patient documentation appears in electronic health record just as if you were present in Parkside’s hospital or clinic. Each appointment is billable as a clinic visit. Technology used in these Telehealth appointments is HIPAA compliant and easy to use. For more information about our Telehealth services, you can call 918-588-8888.
Parkside Psychiatric Hospital & Clinic has a fillable pdf of all required outpatient intake forms
You must complete the Informed Consent form below prior to any telehealth session.
Telehealth Informed Consent for Treatment
I, the undersigned patient, both personally or through the person legally empowered to sign this consent and obligate me as herein contemplated, request and authorize Parkside, Inc., its employees, agents, affiliates (jointly and separately), and physicians to provide hospital care (acute care, residential care, or any of the outpatient programs), upon admission therein, including without limitation, physical examination, routine diagnostic procedures and medical or psychological treatment which is to include whatever procedures that are deemed necessary by the admitting physician and such other physician, assistants, students, or volunteers as s/he may designate. I summarily request and authorize Parkside, Inc. and physician(s) to administer any treatment and perform such other actions as the physician may deem necessary or advisable in the diagnosis and treatment of my illness. If indicated or requested, and with proper written consent, testing for communicable diseases will be performed on physician order. I am aware that the practice of medicine is not an exact science and acknowledge that no warranty, guarantee or assurance has been made thereto by hospital and/or physician as to the result of treatments, examinations or otherwise that may be obtained.
RESTRAINT, SECLUSION, PHYSICIAL HOLDS AND TIME OUTS: Parkside, Inc. reserves the right to restrain, seclude or physically hold any patient clinically determined to be a risk to him/herself or others. Restraints, seclusions and physical holds are performed by physician order consistent with hospital policy and procedure. A patient may request to take a time out or may be asked by a staff member to take a time out if he/she is disrupting the milieu or needs time to regain control of his/her behavior. Time outs do not require a physician’s order and may not exceed thirty (30) minutes duration. CONFIDENTIALITY & DISCLOSURE OF INFORMATION: Parkside, Inc. will honor and respect my protected health information rights according to state and federal laws and the Notice of Privacy Practices. I understand that my medical records and billing information are made and retained by Parkside, Inc. and are accessible to hospital personnel and medical staff. Hospital personnel and physicians in attendance may use and disclose medical information for hospital operations and functions to any other physician or health care personnel involved in my continuum of care for this admission. Safeguards are in place to discourage improper access. Parkside, Inc. and its medical staff are authorized to disclose all or part of my medical record to any insurance provider who is or may become involved with my care. Oklahoma law requires that Parkside, Inc. advise you that the information authorized for disclosure may include information which may be considered a communicable or venereal disease, including, but not limited to, Hepatitis, Syphills, Gonorrhea, Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (AIDS). Communicable diseases will be released to health authorities as required by law.
FINANCIAL RESPONSIBILITY: 1. As consideration for the services provided me, payment is guaranteed for any amount due for such services provided by Parkside, Inc. Hospital charges for services and goods shall be at Parkside, Inc.’s billed charges rates unless otherwise agreed to in writing by Parkside, Inc. Amounts estimated or known to be payable by me become due and payable at the time of discharge including, but not limited to, health insurance deductible and coinsurance amount(s). 2. I understand that Parkside, Inc. will assist with insurance precertification requirements which are the responsibility of the policyholder and/or physician, but will not assume responsibility for precertification or any impact which it may have on insurance payment. I understand that any requirement for completion of insurance precertification is the responsibility of the policyholder. 3. I agree that insurance benefits for Parkside, Inc. charges payable to the insured are to be made payable to Parkside, Inc. and that physician benefits otherwise payable to the insured are to be made payable to the physician(s) responsible for my care. I understand that I am responsible for any charges not covered by this assignment. Any payment received for this period may be applied to any unpaid bills for which I am liable, subject to the rules of coordination of benefits. 4. I agree to comply with all hospital rules and regulations and to participate in the treatment program as prescribed. I agree to reimburse Parkside, Inc. for any damage to the facility or personal property that I may cause or a patient for whom I am legal guardian my cause during the course of treatment.
TELEHEALTH ENCOUNTERS INFORMED CONSENT:
Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of providing patient care. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following: patient medical records, and live two-way audio and video communication. Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. Records of the telehealth encounter will be entered into Parkside’s electronic medical record keeping system and are available from Parkside’s Health Information Management department in accord with regular medical records policy. Expected Benefits: improved access to care, decreased need for travel, more efficient evaluation, obtaining the expertise of a specialist. Possible Risks: telehealth encounter failure due to equipment or connection failure, in very rare instances, security protocols could fail or partially fail causing a possible breach of personal health information. Upon providing your electronic signature, you acknowledge that you understand and agree with the following:
- I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine, which identifies me, will be disclosed to researchers or other entities without my written consent.
- I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.
- I understand the alternatives to telemedicine consultation.
- I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas.
- I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
- I understand that portions of my healthcare information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than my healthcare provider and consulting healthcare provider in order to operate the video equipment. The above-mentioned people will all maintain confidentiality of the information obtained. Health care information transmitted is documented and retained as medical records and is available to the patient. Dissemination to other entities or persons external to the patient practitioner relationship will not occur without written consent of the patient. Parkside maintains no video or recordings of the telehealth encounter.
PERSONAL BELONGINGS & RELEASE OF RESPONSIBILITY:
- Parkside, Inc. is hereby released from any responsibility for personal property I do not provide to it for safekeeping.
- I acknowledge that Parkside, Inc., or employees thereof, shall not be responsible for any personal valuables or belongings including, but not limited to, glasses, dentures, hearing or other prosthetic devices retained on my person or left in any room during my treatment.
- Parkside Inc. is held harmless from any injuries, damages, claims or actions that may arise out of my use of personal equipment.
INPATIENT TREATMENT ONLY:
- I consent to observation and diagnosis for inpatient hospital evaluation and treatment. Care and treatment includes, but not limited to, routine laboratory procedures, diagnostic procedures, body checks, evaluations done by nurses, social workers, psychologists, activity therapist and medical treatment rendered by my physician(s).
- I understand that if the inpatient treatment team determines that I have a substance abuse/dependence problem requiring treatment, I may be required to remain on the unit for all treatment. Visitation may be restricted for a period of time. Any restrictions will be reviewed daily by the inpatient treatment team. The purpose for these requirements is for medical stabilization and prevention of further access to substances that may be abused.
- I understand I can ask to leave at any time after I am admitted; however, if I should choose to leave inpatient treatment Against Medical Advice (AMA), it is my intention to give the staff a written notice 48 hours prior to the time I actually leave the hospital. If it is determined by my physician that I do not pose a danger to myself or others but my physician determines that I need to stay to complete my treatment, and I disagree with that opinion, I will be discharged Against Medical Advice. If I am discharged AMA, I understand that I will not be provided with prescriptions or any outpatient follow-up treatment.
- **I understand that if my physician determines that my discharge might pose a danger to myself or others, I may be detained for up to three (3) business days during which my physician will initiate an involuntary commitment procedure for acute care.
- I understand that should my conduct become disruptive or dangerous to myself or to others, the physician may order treatment with medication, seclusion, or restraint as needed.
- I understand that I have the fundamental right to control decisions relating to the rendering of health care including the decision to have all life-sustaining procedures withheld or withdrawn in instances of terminal condition, and explaining these rights.
INPATIENT AND OUTPATIENT TREATMENT:
- I consent to participate in the development and implementation of the treatment plan, and I understand that such treatment includes, but is not limited to: individual, group, marital, and family conferences, recreational activities and outings, and medical treatment which may be deemed necessary or advisable during my course of treatment.
- I have been informed of my condition, problems related to recovery and likelihood of success.
- I have been informed of proposed interventions, treatments and medications and the potential benefits, risks and side effects to each.
- I have been informed of alternative interventions, treatments, medications and my right to refuse such to the extent permitted by law.
- I recognize that Parkside, Inc. is a teaching facility and consent to the presence of student observers and treatment by supervised resident physicians.
- I understand that my medical records may be reviewed by outside auditors such as Medicare/Medicaid, private insurance companies, the Joint Commission for Accreditation of Healthcare organizations and the Oklahoma State Dept. of Health.
- I understand and authorize the review and/or release of information of my medical records to contacting agencies for services rendered and continued treatment as outlined in the Notice of Privacy Practices.
- ** I have been provided with information regarding the transmission of the AIDS virus, behaviors that can place other and me at risk and information on how to obtain HIV testing, if needed.
- ** I understand that in entering treatment, I must conduct myself in such a way as to protect myself from exposure to or transmission of Infectious diseases such as AIDS, hepatitis, venereal disease, and any other communicable disease.
- ** I acknowledge that I have received information about tuberculosis including: Symptoms of TB, how TB is spread, and the risk factors for TB and how to obtain a test for TB. I have been given an opportunity to have my questions answered.
** I have received copies of the following: Patient and Client Rights, Patient and Client Responsibilities, Medicare Patient and Client Appeal Process, Grievance process and client handbook (which explains hospital rules). As part of my treatment, there may be trips made outside of the hospital and volunteers may be used on occasion.
CERTIFICATION: I hereby certify that I have read the contents of this form and have had the opportunity to ask any questions and obtain explanations to my satisfaction. I certify that I understand its content and significance. I further certify that all information requested during my evaluation is correct to the best of my knowledge. False information or information withheld could result in transfer or discharge. My electronic signature acknowledges I have read this document carefully and understand the risks and benefits of the teleconferencing consultation and have had my questions regarding the procedure explained and I hereby give my informed consent to participate in a telemedicine visit under the terms described herein.
Payment for Services
Payment can be completed using Paypal or credit cards.