Virtual Treatment Consent

The Student Wellness Centre (the "SWC") currently offers virtual care when requested. This means that if available we may use video and/or audio technologies for those patient visits. Some health concerns can be addressed with virtual care alone, but in some cases the Nurse Practitioner may ask you to visit a hospital or other health care facility if necessary, for a physical examination.

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools.

Virtual treatment will involve arranging a mutually agreed upon appointment time when both you and the Nurse Practitioner can meet via the internet or phone. It can also involve the exchange of written information through password protected electronic means (in conjunction with the livestream sessions). The Nurse Practitioner providing virtual treatment to you will be on campus at the SWC. The Nurse Practitioner will be available for virtual treatment only during regular office hours.

If you are concerned about using video or audio tools for virtual care, you can ask the SWC to arrange an in person visit in the University of Regina Clinic (Paskwaw Tower rm 119).

Technology Requirements

To access virtual treatment, you will need a computer with reliable internet access and a webcam. Use a private computer/device (i.e., not an employer’s or third party’s computer/device), secure accounts and a secure Internet connection. For example, using a personal and encrypted email account is more secure than using an unencrypted email account, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection. You will also need access to a telephone during sessions. Our virtual treatment service provider is Zoom for Healthcare. Further instructions for setting up your Zoom link with your Nurse Practitioner will be provided to you via email.

I understand the rights and risks of accessing and receiving virtual treatment services through internet or telephone technology, and agree as follows:

1. I understand that emails, calls or texts I receive are not secure in the same way as a private appointment in an exam room.
2. I understand that electronic communication is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the emergency department when needed (including for any urgent care that may be required).
3. If virtual treatment is not appropriate for my situation, I will be provided with alternatives, including resources and/or contact information for in-person health treatment providers in my area. I understand that an opening with the providers in my area may not be immediately available.
4. I understand that despite all reasonable technology security efforts there remains a risk that the transmission and communication of my virtual treatment sessions may be breached or accessed by unauthorized persons.
5. I understand that it is my responsibility to maintain privacy on the client end of the transmission and communication. I will take precautions such as using a private space, a secure and reliable internet connection, a headset, and muting in the event of an unexpected interruption. It is the responsibility of the Nurse Practitioner to do the same at their end.
6. The applicable privacy laws and the professional ethical standards of my Nurse Practitioner that protect the confidentiality of my health information also apply to virtual treatment services. As such, I understand that the information disclosed by me during the course of my virtual treatment sessions (and over the telephone, by mail, or via email) will in general be kept confidential, and will be used to provide me with health care services.
7. I can be contacted during SWC office hours and messages from my Nurse Practitioner can be left at:
   * Telephone:
   * Email:
8. There is a risk that virtual treatment services could be disrupted or distorted by unforeseen technical problems. In the event of disruption of service, I will be contacted by telephone by my Nurse Practitioner as soon as possible after the disruption. I can be reached at:
   * Telephone:
9. I agree that if I find myself in a life threatening or emergency situation, I will immediately call 9-1-1. If I require within and after-hours crisis-oriented health care services I will contact my local primary or mental health care facility.

I hereby acknowledge that I have read, understand and have accepted all the above terms relevant to receiving virtual treatment from the Interim Health Clinic at the University of Regina, and I consent to receiving virtual treatment through video or audio communications.

* Name of client

Student # (if applicable)

* Yes, I Agree to the terms and conditions set out above