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Behavioral Health Online Consents (Spanish)

Our commitment to keeping you safe

We have never taken for granted the sacred trust you place in us to care for your child, and today we are more grateful than ever for that privilege. To learn about all the ways we are working to keep you, your family and our team members safe, visit our COVID-19 updates page.

Learn More about our commitment to keeping you safe
Learn More about our commitment to keeping you safe

Consentimiento para atención de la salud conductual por Internet

Para poder ser atendido, el consejero (o psicólogo) escolar o el médico familiar deben canalizarlo. Pero para poder hacerlo, deben están inscritos en el programa. Hable con cualquiera de ellos para preguntarles si lo están. Para ser atendido, también es necesario que el padre o tutor rellenen y entreguen los formularios que aparecen abajo.  Una vez que los recibamos, lo llamaremos para darle cita. Si tiene dudas, llame al 844-856-6926.


Formularios para el consejero escolar

Si la familia será canalizada por un consejero escolar participante.

  1. Consentimiento para evaluación inicial: Nos autoriza a hacer la primera llamada de evaluación a los padres y a ofrecer el apoyo de un coordinador de atención médica y un profesional en salud conductual.
     
  2. Información socioeconómica: Esta información nos permitirá crear su expediente de salud conductual a distancia en la base de datos de Children’s Health.
     
  3. Divulgación de la información: Nos autoriza a compartir la información de salud conductual con el personal de la escuela.

Formularios para el consejero escolar


Formularios para el médico o profesional clínico familiar

Si la familia será canalizada por un médico o profesional clínico familiar participante.

  1. Consentimiento para evaluación inicial: Nos autoriza a hacer la primera llamada de evaluación a los padres y a ofrecer el apoyo de un coordinador de atención médica y un profesional en salud conductual.

  2. Información socioeconómica: Esta información nos permitirá crear su expediente de salud conductual por Internet en la base de datos de Children’s Health.

Formularios para el médico o profesional clínico familiar


Consentimientos para el tratamiento

Para las familias que recibirán el servicio de salud conductual en persona o por Internet.

  1. Consentimientos generales de atención ambulatoria: Nos autoriza a ofrecer servicios en persona y a distancia, y a compartir información de salud y médica para efectos de facturación. 
     
  2. Consentimiento para atención psicológica: Nos autoriza a ofrecer terapia individual y familiar con un profesional en salud conductual.

Consentimientos para el tratamiento


Formulario de consentimiento para el tratamiento

Nos autoriza a ofrecer terapia individual y familiar con un profesional en salud conductual.

Formulario de consentimiento


Divulgación de la información 

Las familias llenarán este formulario si es necesario.

Nos autoriza a compartir la información de salud con especialistas y demás personas indicadas en el formulario.

Divulgación de la información

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