№ files_lp_3_process_7_050752
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Undated informed consent form outlining conditions, risks, confidentiality terms, technical requirements, and emergency procedures for psychiatric telemedicine services provided in McKinney, Texas.
Title:
Informed Consent Checklist for Telemedicine Services
Organization:
Psychiatric Associates
Practitioner:
Lloyd D. Bellah, M.D.
Address:
1650 W. Virginia, Suite 202, McKinney, TX 75069
Contact Phone:
972-542-5490
Document Type:
Informed Consent Form
Subject:
Telemedicine and Video-Conferencing Psychiatric Services
Geographic Scope:
McKinney, Texas
Applicable To:
Patients receiving telemedicine services
Requirements:
Confidentiality agreement, secure internet connection, private setting, emergency and backup contact information, insurance verification
Signatures Required:
Psychiatrist and Patient or Patient’s Legal Representative
Price: 8 / 10 USD
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Year:
2023
Document type:
Regulatory addendum
Issuing body:
Department of Health
Version:
V2012
Subject:
Telemedicine services reimbursement and tariff pricing
Rule effective date:
31 July 2023
Replaces:
Addendum 3
Scope:
All healthcare facilities
Applicable specialties:
All specialties excluding Psychiatry/Psychology; Psychiatry/Psychology
Payment model:
Telemedicine services
Tariff system:
Mandatory Tariff Pricelist Application Rules
Coding system:
CPT
CPT codes covered:
99441, 99442, 99443, 99091, 99446, 99447, 99448, 98966, 98967, 98968, 90791, 90792, 90833
Pricing currency:
Not specified
Compliance requirement:
Minimum telemedicine technology requirements as prerequisite for payment eligibility
Year:
2021
Region / City:
Texas
Subject:
Medicaid Policy, Telemedicine, Gynecology, Family Planning
Document Type:
Draft Policy
Organization / Institution:
Texas Health and Human Services Commission (HHSC)
Author:
Texas Health and Human Services Commission (HHSC)
Target Audience:
Medicaid Providers, Healthcare Providers, Policy Makers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2026
Region / City:
Florida
Subject:
Telemedicine, Consent to Treatment
Document Type:
Consent Form
Institution:
Palm Beach Wellness Institute
Author:
Not specified
Target Audience:
Patients receiving medical treatment at Palm Beach Wellness Institute
Effective Period:
Indefinite, until withdrawal of consent
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2023
Region / City:
Not specified
Topic:
Telemedicine billing, medical education
Document Type:
Instructional guide
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Medical professionals, residents, preceptors
Effective Period:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Event:
First International Conference and Exhibition for e-Health and Telemedicine
Document Type:
Academic paper template and submission guidelines
Language:
English (abstract required in Arabic and English)
Required Software:
Microsoft Word
Font Requirements:
Times New Roman (English), Simplified Arabic (Arabic)
Font Size:
10 pt (text), 12 pt (main headings), 11 pt (sub-headings), 14 pt (abstract headings)
Line Spacing:
1.0
Page Margins:
0.97 inches on each side
Paper Length:
Minimum 5 pages, Maximum 15 pages
Abstract Length:
Not more than 350 words
Sections Included:
Abstract, Keywords, Introduction, General Structures, Style, Figures and Tables, Equations, Results, Conclusions, Recommendations, References, Author CV
Figure and Table Placement:
Figures at bottom, tables at top
Equation Formatting:
Numbered consecutively in parentheses aligned right
Reference Style:
Numbered citation style with full bibliographic details
Author Information:
Names, affiliations, email addresses, and CV (max 75 words) with photo
Submission Condition:
Papers must strictly follow this format
Year:
2026
Country:
India
Topic:
Telemedicine, eHealth, ICT in Healthcare
Document Type:
Academic Article
Institution:
Yutthara Muleyya Shwantrao Chavan Law College
Author:
Not specified
Target Audience:
Healthcare professionals, legal scholars
Keywords:
Telemedicine, eHealth, ICT, doctors, law
Historical Context:
Development of telemedicine in India from 1999 to early 2000s
Legal Framework:
Indian telemedicine regulations and policies
Technological Context:
Use of ICT, SATCOM networks, digital health services
Year:
2021
Region / City:
Texas
Topic:
Medicaid policy review
Document Type:
Policy Draft
Organization / Institution:
HHSC (Health and Human Services Commission)
Author:
Texas HHSC
Target Audience:
Medicaid providers, healthcare professionals, obstetricians, and licensed midwives
Period of Validity:
Indefinite, subject to review
Approval Date:
Not specified
Date of Changes:
Public comment period starts in 2021
Scope:
Medicaid medical policy
Policy Code:
Not specified
Year:
Not applicable
Region / City:
Not applicable
Subject:
Research ethics and manuscript submission
Document Type:
Submission Template
Organization / Institution:
Not applicable
Author:
Not applicable
Target Audience:
Researchers, Authors submitting manuscripts
Period of validity:
Not applicable
Approval Date:
Not applicable
Date of Changes:
Not applicable
Note:
Year
Region / City:
Buffalo, NY
Topic:
Research Study Consent
Document Type:
Informed Consent Form
Institution:
University at Buffalo
Author:
University at Buffalo Research Compliance
Target Audience:
Research Participants
Year:
2016
Region / City:
United States
Topic:
Electronic Informed Consent (eIC)
Document Type:
Guidance
Agency / Institution:
Office for Human Research Protection (OHRP), Food and Drug Administration (FDA)
Author:
Office for Human Research Protection (OHRP), FDA
Target Audience:
Researchers, IRBs, Clinical Investigators, and Study Participants
Period of Validity:
Ongoing
Approval Date:
December 2016
Date of Revisions:
Not specified
Year:
2018
Region / City:
United States
Theme:
Cancer prevention, clinical trials
Document Type:
Template
Organ / Institution:
National Cancer Institute (NCI), National Institutes of Health (NIH)
Author:
NCI
Target Audience:
Researchers, clinical trial participants
Period of Validity:
Ongoing
Approval Date:
January 19, 2018
Date of Changes:
N/A
Note:
Year
Topic:
Human Subject Research
Document Type:
Informed Consent Form
Organization / institution:
Coastal Carolina University
Author:
[PI Name]
Target Audience:
Potential research participants
Year:
Not specified
Region / City:
Not specified
Topic:
Research ethics, informed consent
Document Type:
Addendum
Institution / Organization:
Columbia University
Author:
Not specified
Target Audience:
Research participants
Period of validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Note:
Year
Topic:
Research Ethics
Document Type:
Guidelines
Organization / Institution:
EIU IRB
Target Audience:
Researchers, Institutional Review Board Members
Year:
2025
Topic:
Free, Prior and Informed Consent (FPIC)
Document type:
Protocol
Organization / institution:
Blue Action Fund
Author:
Blue Action Fund
Target audience:
NGOs, project developers, indigenous peoples, local communities
Period of validity:
Not specified
Approval date:
Not specified
Date of modifications:
Not specified
Year:
2023
Region / City:
United States
Topic:
Informed Consent, Research Ethics
Document Type:
Research Guidelines
Organization:
U.S. Department of Health and Human Services, Office for Human Research Protections
Author:
Not specified
Target Audience:
Researchers, Institutional Review Board (IRB) members
Validity Period:
Not specified
Approval Date:
Not specified
Date of Last Update:
Not specified
Year:
2016
Region / City:
Dublin
Topic:
Research Consent Forms
Document Type:
Template
Organization:
Trinity College Dublin
Author:
Trinity College Dublin
Target Audience:
Researchers in historical, social, economic or scientific fields
Period of Validity:
Indefinite
Approval Date:
2016
Modification Date:
N/A
Context:
Template for preparing an informed consent form for use in historical, social, economic, or scientific research, ensuring compliance with EU General Data Protection Regulation.
Document type:
Instructional guidance
Subject:
Informed consent forms in clinical research
Context:
Clinical trials involving human participants
Regulatory and ethical framework:
Research ethics and regulatory compliance
Organizations referenced:
Children’s Oncology Group; National Cancer Institute; National Institutes of Health; OCREB
Funding context:
Public funding by the National Cancer Institute
Intended audience:
Consent form authors; clinical trial investigators; participating centres
Geographic scope:
North America
Population referenced:
Children and adolescents with cancer; parents or legal guardians
Related materials:
Provincial informed consent form templates; lay terminology glossary
Note:
Year
Document Type:
Research Consent Form
Organ / Institution:
Ross University School of Veterinary Medicine
Target Audience:
Animal owners