C. Before providing psychological service by
telepractice, a licensee shall:
1. Obtain the
written informed consent of the client or patient, using language that is clear
and understandable and consistent with accepted professional and legal
requirements. The licensee shall ensure the written informed consent addresses
the following and a copy is placed in the client or patient's record required
under R4-26-106:
a. The manner in which the licensee will
verify the identity of the client or patient before each psychological service
if the telepractice does not involve video;
b. The manner in which the licensee will
ensure the client or patient's electronic communications are received only by
the licensee or supervisee;
c.
Limitations and innovative nature of using technology to provide psychological
service;
d. Inherent
confidentiality risk resulting from use of technology;
e. Potential risk of technology failure that
disrupts provision of psychological service and how to re-establish
communication if disruption occurs;
f. When and how the licensee will respond to
routine electronic communications;
g. The circumstances under which the licensee
and client or patient will use an alternative means of communication;
h. Who is authorized to access the electronic
communication between the licensee and client or patient;
i. The manner in which the licensee stores
the electronic communication between the licensee and the client or patient;
and
j. The type of secure
electronic technology the licensee will use to communicate with the client or
patient;
2. Establish a
written agreement with the client or patient that specifies contact information
for sources of face-to-face emergency services in the client or patient's
geographical area and requires the client or patient to contact a source of
face-to-face emergency services when the client or patient experiences a
suicidal or homicidal crisis or other emergency. If the licensee has knowledge
the client or patient is experiencing a suicidal or homicidal crisis or other
emergency, the licensee shall assist the client or patient to contact a source
of face-to-face emergency services. The licensee shall place a copy of the
written agreement required under this subsection in the client or patient's
record required under
R4-26-106.
3. Obtain the name and contact information
for an emergency contact;
4. Obtain
information about an alternative means of contacting the client or patient;
and
5. Provide the client or
patient with information about an alternative means of contacting the
licensee.
