Confidentiality Agreement Form For Group Counseling

While Ethos` telemedicine options, including Zoom, Facetime, and Cisco Web, are optimized for data protection, Ethos may not have formal counterparty agreements with these services (and no such agreement is available with Facetime), which may result in technical legal data protection issues. Customer agrees that these third-party services serve as a channel for the Customer`s protected health information and may have access to such information. The customer also understands that if the customer is not in a private location during access to telemedicine, others may see or listen to the customer`s protected health information. Therefore, the customer accepts and authorizes Ethos to transmit the customer`s protected health information to its telemedicine providers or to persons present with the customer, if the customer accesses Ethos` telehealth service, to the extent necessary for the use of Ethos` telehealth services for the purpose of the customer`s treatment. . . .