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Supplemental Informed Consent

Behavioral Health Services in the Era of COVID-19

Thank you for your continued trust in our organization. As with the transmission of any communicable disease, like a cold or the flu, you may be exposed to COVID-19, also known as “Coronavirus”, at any time or in any place. Be assured that we have always followed state and federal regulations and recommended universal personal protection to limit transmission of all diseases in our office and continue to do so.

Despite our careful attention to cleaning, disinfection, and use of face coverings, there is still a chance that you or your child could be exposed to an illness in our office or during community-based sessions, just as you might be at your gym, grocery store, or favorite restaurant. “Social Distancing” nationwide has reduced the transmission of the Coronavirus. Although we have taken measures to provide social distancing in our organization, due to the nature of the services we provide, it is not possible to maintain social distancing between clients, caregivers, staff, and sometimes other clients at all times.

Although exposure is unlikely, do you accept the risk and consent to treatment?

Do you agree to comply with OCP’s COVID-19 Policies and Procedures Addendum (copy available upon request) including completing a Health Screening prior to each session and the use of face coverings on OCP property and during clinical sessions (with the exception of children ages 2 and under and those with a medical limitation)?

Do you agree to comply with all public health requirements in the event of possible exposure to COVID-19 including contact tracing reporting?

Do you agree to OCP complying with all Public Health requirements including sharing the names of any visitors to the OCP building that may have been exposed to COVID-19, if required for contact tracing?

Do you agree to the use of Telehealth services where appropriate to decrease the risk of exposure?

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June 9, 2020 3:09 pm PDT

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June 9, 2020 3:26 pm PDT

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