[04/26/23] ONN will be resuming part-time and limited in-person services. Please read through our Informed Consent for In-Person Services:

INFORMED CONSENT FOR IN-PERSON SERVICES
This document contains important information about ONN’s decision to begin/resume in-person services in light of the COVID-19 public health crisis. Our decision is based in part on recommendations by the Center for Disease Control (CDC), but other factors are considered. Some of these include but are not limited to: whether we and our families have been vaccinated, our health or the health of those we are in close contact with, and risk of exposure outside of this setting.

Please read this carefully and let your provider or any ONN intake staff know you have any questions. When you sign this document, it will be an official agreement between us.

Decision to Meet Face-to-Face
We have agreed to meet in person for some or all future sessions. If there is a resurgence of the pandemic or if other health concerns arise, however, ONN may require that we meet via telehealth. If you have concerns about meeting through telehealth, please email intake@owlsnestnorth.com or speak directly with your provider, so that we may address any issues. You understand that, if any ONN staff believe it is necessary, it may be determined that we return to telehealth for everyone’s well-being.

If you decide at any time that you would feel safer beginning or resuming telehealth services, ONN respects and supports that decision, if it is feasible and clinically appropriate. Reimbursement for telehealth services is also determined by the insurance companies and applicable law, so we’ll discuss any financial implications, if any.

Risks of Opting for In-Person Services
You understand that by coming to the office, you are assuming the risk of exposure to the coronavirus (or other public health risk). This risk may increase if you travel by public transportation, cab, or ridesharing service. ONN assumes no responsibility or liability for exposure to illness while you are accessing services. This risk and subsequent consequences are yours alone to accept (or decline in favor of telehealth).

Your Responsibility to Minimize Your Exposure
To obtain services in person, you agree to take certain precautions which will help keep everyone (you, me, and our families, ONN’s community and other patients) safer from exposure, sickness and possible death. If you are unable to agree to these safeguards, it may be necessary to begin/resume telehealth services. You agree to:

• Keep your in-person appointment if you are symptom free only.
• Keep your in-person appointment if you have been fever free for a minimum of 10 days prior to our appointment.
• Return to the building only after testing negative for COVID, if you are known to be infected.
• Notify your provider and accept a telehealth appointment if you have been in contact with someone who has tested positive within the last 14 days.
• Notify your provider and convert your in-person appointment to telehealth if your temperature is elevated (100 Fahrenheit or more), or if you have other symptoms of the coronavirus.
• Wait in your car or outside until your provider gives you access to the building.
• Wear a mask that covers your mouth and nose entirely while using common areas of the building.
• Remain fully masked until inside your therapy office and mutual consent has been established.
• Wash your hands or use alcohol-based hand sanitizer when you enter the building.
• Adhere to the social-distancing precautions when inside the building.
• Keep a distance of 6 feet and there will be no physical contact (e.g. no shaking hands) with others.
• If you are bringing your child, you will make sure that your child follows all of these sanitation and distancing protocols.
• You will take steps between appointments to minimize your exposure to COVID.
• If you have a job that exposes you to infected people, you will notify your provider.
• Discuss with your provider if your commute or other responsibilities/activities put you in close contact with others (beyond your family.
• Immediately notify your provider if you or a resident of your home tests positive for the infection, and resume telehealth services.

ONN reserves the right to change the above precautions if additional local, state or federal orders or guidelines are published. Your provider will discuss these changes with you as they occur.

ONN’s Commitment to Minimize Exposure

ONN has taken steps to reduce the risk of spreading the coronavirus within the office and we have posted our efforts on our website and in the office. Please let your provider know if you have questions about these efforts.

If You or I Are Sick
You understand that I and ONN are committed to keeping you, me, ONN’s staff and all our families safe from the spread of illness. If you show up for an appointment and ONN’s staff believe that you have a fever or other symptoms, or believe you have been exposed, we will require you to leave the office immediately. We will follow up with services by telehealth as appropriate.

If I or any ONN staff utilizing the building test positive for the COVID, you will be notified so that you may take appropriate precautions.

Your Confidentiality in the Case of Infection
If you have tested positive for the coronavirus and anyone was exposed during in-person services, your provider will notify other ONN staff, but your confidentiality will be maintained.

Informed Consent
This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.

[03/24/20] In response to the COVID-19 pandemic, and for the safety of our community, we are currently providing services 100% through Telehealth (phone and/or HIPAA-compiant videoconference platforms) until further notice.

[03/13/20] First, we want you to know that we are taking the latest news about COVID-19 and the recommendations from health authorities very seriously. Protecting your health, the health of our staff and clients and ensuring that everyone is getting the best care possible is our highest priority.

You might be feeling overwhelmed by the amount of information you are receiving. We are closely following the recommendations of the CDC, the Oregon Health Authority and experts in the field imbued with our own common sense and skepticism around what information is shared “for our protection.” We are committed to providing accurate and timely information as this situation is quickly evolving and making choices that are informed by our values, including community health and strength.

Governor Kate Brown banned events with more than 250 people and the Oregon Health Authority issued new guidelines to help reduce the spread of the virus.

What does this mean for ONN and our clients?

• We are regularly disinfecting surface areas throughout the day and withdrawing use of commonly used items, such as hand towels
• We are insisting that staff and clients remain home if they feel any tickles of illness, fatigue or at high risk of illness
• We are keeping clients abreast of any changes in routine for their care
• We are maintaining a policy of no physical contact with our clients and, if possible, a 6′ radius of physical distance
• We are encouraging staff and clients to attend to their own impulses/intuition around physically isolating and scheduling phone or (HIPAA-compliant) videoconferencing sessions instead of in-office visits. If this is what you prefer, please:
  • Contact your clinician with as much notice as possible to set this up
    
  • Sign and deliver a hard copy of the our technology consent where possible. Where not, provide your clinician email consent and include a verbal discussion of risks/benefits

Please let us know if you have any further needs. With our mutual commitment, we will all get through this with minimal disruption and maximum safety.