Terms & Conditions – VIMHANS OPD Consultations

TERMS & CONDITIONS – VIMHANS OPD Consultations

FOR PSYCHIATRY, PSYCHOTHERAPY & COUNSELLING SERVICES AT VIMHANS OUT-PATIENT DEPARTMENT

By initiating or continuing consultations at VIMHANS Hospital, you affirm that you have - read and understood these T&Cs; had the opportunity to ask questions and seek clarification; agreed to abide by the terms, especially with respect to crisis protocols, communication limits, and client responsibility during emergencies. VIMHANS may modify these Terms & Conditions at any time without prior notice. It is recommended that you regularly review them.

1. GENERAL TERMS

Below are generalised terms for availing services at VIMHANS that clients and caregivers should consider as their responsibilities so that the hospital and healthcare providers can perform their work satisfactorily:

1.1. All Clients registered for mental health services at VIMHANS are mandated to provide information of their guardian/*nominated representative/caregiver/accompanying person/emergency contact for the institution’s records. This information is kept strictly confidential with the institution.

Note: “Nominated Representative” is any person appointed & identified as reliable by the client for the purpose of reaching out in case of an emergency and/or for the purpose of taking decisions on behalf of the Client when he/she lacks capacity and for carrying out duties under the MHCA 2017.

1.2. The client acknowledges that certain emotional discomfort, distress, or psychological upheaval may arise during the consultation, particularly when processing sensitive material. Such experiences are considered a normal and anticipated aspect of the process and shall not be construed as negligence or malpractice on the part of the clinician or the institute, provided care has been rendered in good faith and in accordance with professional standards.

1.3. The Client acknowledges that mental healthcare is a collaborative partnership between the client and their Mental Health Provider [“MHP”]. While the MHP serves as a skilled, experienced, trained facilitator and guide, the ultimate responsibility for change and growth lies with the Client. The Client’s active participation is essential for achieving positive outcomes.

1.4. Services in mental healthcare do not offer guaranteed, immediate, or uniform results across individuals or timeframes. Outcomes are influenced by a range of factors including, but not limited to:

• The nature, severity, and chronicity of the client’s concerns;
• The client’s engagement, openness, and participation in the process;
• External environmental, relational, and medical factors;
• Therapeutic goals mutually identified and reviewed during the process over time.

1.5. No specific timeframe for progress or resolution is promised or implied, and any perceived delays in improvement shall not constitute negligence, breach, or deficiency in service, provided that care has been rendered in accordance with recognized professional standards and ethical norms.

1.6. Clients are strictly prohibited from attending any consultations while under the influence of:

• Alcohol
• Illicit substances
• Non-prescribed psychoactive or controlled substances.

This includes any chemical or intoxicating substance that may impair judgment, cognition, emotional regulation, or behavioural control, and which has not been lawfully prescribed by a registered medical practitioner for legitimate medical purposes.

1.7. Client Rights:

Clients have patient rights, so that they can make an informed decision when they avail healthcare services. Here is a comprehensive list:

• Right to dignity, privacy, and non-discrimination
• Right to informed consent at all stages of assessment and treatment
• Right to withdraw from therapy at any point without prejudice
• Right to change mental health provider
• Right to access personal records, subject to clinician review
• Right to receive evidence-based, ethical, and professional care.

VIMHANS Clients may share feedback or file complaints regarding the services received. All concerns will be reviewed respectfully and confidentially by the VIMHANS Ethics or Grievance Cell. Please write to administrator@vimhans.com

2. RESCHEDULING, CANCELLATION & REFUND POLICY

2.1 RESCHEDULING appointments:

• For all Confirmed or Provisional Appointments for Consultation at VIMHANS or online, rescheduling such appointment can ONLY be done by calling or visiting VIMHANS Hospital, Nehru Nagar (Monday to Saturday, 9 am to 8 PM)
• Information received from any other communication channels will not be considered, as these are less efficient.
• Kindly inform as soon as possible to allow us to serve you best, while being accessible for anyone else in need of the opportunity.
• Requests for rescheduling will be entertained only once, depending on availability of the Consultant and Client.
• No cancellation is necessary for rescheduling the appointment.
• Requests for rescheduling will be entertained upto 12 hours before the scheduled appointment. Any information for rescheduling received beyond 12 hours or not confirmed by the VIMHANS OPD COORDINATOR will NOT be considered.

Kindly note:

• For all Confirmed or Provisional Appointments, rescheduling such appointment can be done only for the respective hospital and of the same consultant.
• Rescheduling of all Confirmed or Paid appointments can be done only until the invoice against such appointment is generated. Once the invoice is generated, cancellation and refund process as mentioned below should be followed and re-process for a fresh booking, if need be.

2.2. CANCELLATIONS and REFUNDS

2.2.1. Cancellation by the Client:

• For any confirmed/ paid appointments, where services cannot be availed at the appointed time despite invoices being generated against such appointment booking, cancelling such appointment can ONLY be done by calling or visiting VIMHANS Hospital, Nehru Nagar (Monday to Saturday, 9 am to 8 PM)
• Requests for cancellations will be entertained upto 24 hours before the scheduled appointment. Any information for cancellation received beyond 24 hours or not confirmed by the VIMHANS OPD COORDINATOR will NOT be considered.
• We will refund the money the way the payment was received. If the payment was by Credit/Debit Card or Net-Banking, we will refund through the Credit/Debit Card or Net-Banking account.
• VIMHANS registration charges, once paid, are non-refundable under any circumstance.

2.2.2. Cancellation by VIMHANS:

Occasionally, OPDs or appointments are cancelled or postponed by the Mental Health Provider/VIMHANS. Should this occur, we will attempt to contact you and refund the amount as per the VIMHANS refund policy (2.3). You may book a new appointment as per your convenience through the VIMHANS OPD COORDINATOR or visit our website for a new booking.

2.3 PROCESSING REFUNDS:

• Typically refunds are processed in 3 working days. Please note that we shall not be responsible for any delays in credit to the Cardholder's credit card account/accountholder’s bank account as that is managed by the Cardholder's issuing bank.
• You are to use a provided refund reference number/ invoice number for further communication in this respect.
• No refunds/cancellation requests shall be entertained in case of payment against bills/Services received.

3. VIMHANS TELECONSULTATION SERVICES

3.1. Telemedicine involves the use of electronic communications to enable health care professionals at different locations to share individual client medical information for the purpose of improving client care. Professionals may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up any/or health education, provider and client education, health information services, and self-care via telecommunications and digital communication technologies.

Telemedicine applications can be classified into four basic types, according to the mode of communication, timing of the information transmitted, the purpose of the consultation and the interaction between the individuals involved—be it provider-to-client/caregiver, or provider-to-provider.

3.1.1. Mode of Communication:

• Video (VIMHANS Meet, 3rd Party, Apps, Video Or Chat platforms, Skype/Facetime etc.)
• Audio (Phone, Apps etc.)
• Text Based:
  • Telemedicine chat-based applications (specialized telemedicine smartphone Apps, Websites, other internet-based systems etc.)
  • General messaging/text/chat platforms (WhatsApp, GMeet, Facebook)
  • Asynchronous (email etc.)

3.1.2. Client’s Information:

A CONSULTANT would use his/her professional discretion to gather the type and extent of client information (history/examination findings/Investigation reports/past records etc.) required to be able to exercise proper clinical judgement. This information can be supplemented through conversation with a healthcare worker/provider and by any information supported by technology-based tools:

• Client Medical Records
• Medical images
• Live two-way audio and video
• Output data from medical devices and sound and video files

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

3.1.3. Client is responsible for the accuracy of information:

During the course of tele-consultation, if the Mental Health Provider inquires for relevant information from the client, then the client is supposed to disclose the right information. The Telemedicine Practice Guidelines in India, released by the Ministry of Health and Family Welfare have clarified that it is the client who will be responsible for accuracy for the information shared with the Mental Health Provider, and not the Mental Health Provider.

3.1.4. Caregiver is deemed to be authorized on behalf of minor or incapacitated clients:

If the age of the client is 18 years or less or if the client is incapacitated then the caregiver is deemed to be authorized to consult on behalf of the client. The Telemedicine Guidelines from Medical Council of India, circulated April 2020, clarify that in such cases, the teleconsultation can take place with the caregiver without the presence of the client.

3.1.5. Prescription to clients:

A physical/digital copy of a regular prescription can be sent to the client soon after TELECONSULTATION by any means, i.e., Patient Profile, WhatsApp messaging, e-mail, etc.

3.2 LIMITATIONS OF TELE-CONSULTATION:

3.2.1. Possible Risks:

As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:

• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the health provider and consultant(s)
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors

3.2.2. Limitations of various modes of communication:

(i) VIDEO: VIMHANS Meet, Apps, Video or chat platforms, Facetime etc.

• is dependent on high quality internet connection at both ends, else will lead to a suboptimal exchange of information
• Since there is a possibility of abuse/misuse, ensuring privacy of clients in video consults is extremely important

(ii) AUDIO: Phone, VOIP, Apps etc.

• Non-verbal cues may be missed
• Not suitable for conditions that require a visual inspection (e.g. skin, eye or tongue examination), or physical touch
• Client identification needs to be clearer, greater chance of imposters representing the real client

(iii) TEXTBASED: Specialized Chat based Telemedicine Smartphone Apps, SMS, Websites, messaging systems e.g. WhatsApp, Google Hangouts, FB Messenger

• Besides the visual and physical touch, text-based interactions also miss the verbal cues
• Difficult to establish rapport with the client
• Cannot be sure of identity of the Mental Health Provider or of the client

(iv) ASYNCHRONOUS: Email, recordings etc.

• Not a real-time interaction, so just one-way context is available, relying solely on the articulation by the client or caregiver
• Client identification is document based only and difficult to confirm
• Non-verbal cues are missed. There may be delays because the Mental Health Provider may not see the mail/file immediately

3.2.3 Adequate Examination:

If a physical examination is critical information for consultation, CONSULTANT may or may not proceed until a physical examination can be arranged through an in-person consult.

3.2.4 Virtual Physical Examination:

A “Full Physical Examination” (FPE) which is considered as the corner stone of medical consultations is understandably not possible in telemedicine.

3.3. DISCLAIMER:

The above terms and conditions do not in any way constitute an invitation or recommendation to avail the tele-consultation services. The services provided through tele-consultation portals are not intended in any ways to be a substitute for face to face consultation with a Mental Health Provider. VIMHANS advices the users to make independent assessment in respect of availing the service, analyse its accuracy or usefulness and suitability prior to making any decision in reliance hereof. When you use these telemedicine consultation services, you will enter into a provider-client relationship and be treated by a licensed provider. The professionals, in exercising their professional judgment, reserve the right to deny care for any reason, including instances where provision of care would be medically or ethically inappropriate.

4. TERMS OF CONFIDENTIALITY

• VIMHANS shall take all reasonable precautions to preserve the confidentiality and prevent any corruption or loss, damage or destruction of the data and information provided by the client and shall not be shared with any third party without the client’s informed and written consent, except under the circumstances stated in Clause 4.3. “Exceptions to Confidentiality”.
• If consultation process involves telecommunication - electronic communication (email, video calls, text messaging), the client is requested to understand and acknowledge that these mediums carry inherent security risks despite best efforts to ensure privacy.
• However, VIMHANS reserves the right to perform statistical analyses on your personal data and information. For details on the confidentially and privacy policy refer to the Online Privacy Statement.
• Certain services on the VIMHANS website may require authentication procedures and enable you to access such services by using a user ID and password. VIMHANS shall take reasonable care to ensure the security of and to prevent unauthorized access to the services, which are part of the website, however you will be the sole and exclusive owner of user ID and the password.
• You are urged to change your password at regular intervals. In addition to user ID and password, VIMHANS may, at its discretion, require you to adopt such other means of authentication.
• You are cautioned that use of cyber-cafe/shared computer for payment transaction at a shared terminal is risky and you are urged not to use a cyber-cafe/shared computer terminal for any such transactions.

4.2. Peer Consultation & Supervision:

In keeping with standards of practice, the healthcare provider may consult with other mental health Provider(s) regarding the care and management of the Client’s case. The purpose of this consultation is to ensure quality of care. The healthcare provider will maintain complete confidentiality and protect the Client’s identity by anonymising information.

4.3. Exceptions to Confidentiality:

The duty of confidentiality shall not apply in the following circumstances:

• Where disclosure is mandated by a court of law, statutory authority, or by any provision of law for the time being in force.
• Where, in the reasonable professional judgment of the treating clinician, the client poses a serious and imminent risk of harm to self or others.
• When disclosure is necessary for insurance or treatment coordination (with consent).
• Where required under specific legislation, including but not limited to:
  • The Protection of Children from Sexual Offences (POCSO) Act, 2012
  • The Domestic Violence Act, 2005
  • Juvenile Justice (Care and Protection of Children) Act, 2015

4.4. In cases where based on clinical evaluation, the client is deemed to lack the mental capacity to make informed decisions (as per Section 4, MHCA 2017), relevant information may be disclosed to the nominated representative/deemed nominative representative/guardian/caregiver - to enable such persons to fulfill his/her duties under the Mental Healthcare Act, 2017 and in accordance with the best interests of the client, subject to statutory safeguards.

4.4. In the case of minors, information may be shared with parents/legal guardian only to the extent necessary and in accordance with the client’s best interests. Wherever feasible and appropriate, assent or informed consent shall be sought from the client prior to such disclosures.

5. CONTACT BETWEEN SESSIONS

5.1. Non-Emergency Communication:

• Any updates, information, or requests outside session time must be shared via the healthcare provider’s specified official email ID only.
• Personal mobile numbers, WhatsApp messages, or texts are not the official modes of communication.
• If any of the non-official modes of communication are used - pursuant to specific consent of the healthcare provider, such messages must be limited to working hours (10:00 AM to 6:00 PM, Monday to Saturday) only.

5.2. Emergency Communication between Sessions:

5.2.1. In urgent cases, clients may contact the hospital reception at 011-4099000, which will attempt to arrange a call with the available/treating clinician, subject to clinical availability.

5.2.2. Clients may also be redirected to the hospital’s on-call psychiatrist or emergency department if the healthcare provider is unavailable.

6. CRISIS SITUATIONS

6.1. A ‘crisis situation’ shall mean: Any acute psychological or behavioural episode that poses an imminent risk to the life or safety of the client or others, including but not limited to:

A clear and immediate likelihood of suicide attempt; serious self-harm; severe psychotic episode with potential for harm; severe dissociation or violent conduct; acute substance intoxication posing immediate danger; any other mental health emergency requiring immediate intervention.

This includes both in-session and between-session episodes that require urgent mental health support and safety-based intervention.

6.2. Crisis and Risk Assessment Criteria:

6.2.1. The Clinicians assess risk of crisis based on the clinical judgment/structured assessments/behavioural observations. The systematic risk assessment procedures evaluate:

(i) Suicide Risk Factors:

• Current suicidal ideation, intent, or planning
• History of previous suicide attempts
• Access to means of self-harm
• Presence of protective factors or lack thereof
• Severity of depression, hopelessness, or
• Psychosis
• Substance abuse or dependence
• Social isolation or lack of support systems

(ii) Violence Risk Factors:

• Expressed threats or intent to harm others
• History of violent behavior
• Presence of paranoid ideation or command hallucinations
• Substance use affecting judgment
• Access to weapons or means of violence

(iii) General Risk Indicators:

• Severe mental health symptoms requiring immediate attention
• Acute deterioration in functioning
• Medical emergencies related to mental health conditions
• Inability to care for basic needs

6.3.1. Risk assessment is an ongoing process throughout the therapeutic relationship and may be updated based on changing clinical presentation or circumstances.

6.3.2. Clients are reminded that while the confidentiality of all therapy content is respected, however, in crisis situations or in dealing with non-cooperative clients (including potential suicide, harm to others, or severe psychological breakdown), clinicians may be legally and ethically obligated to share information with:

• The Nominated representative (NR) - any person appointed & identified as reliable by the client for the purpose of reaching out in case of an emergency and for the purpose of taking decisions on behalf of the Client when he/she lacks capacity and carrying out duties under the MHCA 2017);
• Caregiver(s); or
• Authorities such as police or mental health emergency services, in accordance with Sections 23(4) and 94 of the Mental Healthcare Act, 2017 - in case of absence of NR/family or other caregiver including friends etc.

6.4. Immediate response

In the event of an emergency situation arising during the presence of the Client at the institutional premise for their psychiatric/psychotherapy/counseling session, the clinician with aid of the hospital staff may:

• Provide immediate stabilization and safety measures
• Conduct emergency psychiatric evaluation
• Coordinate with emergency services if required
• Involve family members or nominated representatives as clinically appropriate

6.5. Limitation of Institutional Responsibility

IMPORTANT NOTICE: While the Hospital endeavors to provide appropriate clinical support and guidance during crisis situations, the following limitations apply:

(i) Client/Caregiver Responsibility:

• The final responsibility for implementing crisis management strategies rests with the Client and/or their caregiver/nominated representative
• Final decisions regarding seeking emergency medical attention, hospitalization, or other interventions remain with the Client/caregiver
• The Hospital cannot guarantee the availability of staff for crisis calls outside of regular business hours.

(ii) Limitation of Liability:

• The Hospital and its staff shall not be held legally or clinically responsible for outcomes resulting from the client's or caregiver's decision to act or not act upon the guidance provided.
• The Hospital's obligation is limited to providing clinically appropriate guidance and support within the scope of outpatient mental health services.
• Emergency situations requiring immediate medical intervention are beyond the scope of outpatient services.

CLIENT ACKNOWLEDGMENT AND CONSENT

I, _________________________________ (Client Name), hereby acknowledge that:

1. I have read and understood these Terms and Conditions in their entirety
2. I understand the nature and scope of services provided
3. I understand the definition of Crisis Situations and the Hospital's response protocol
4. I understand the limits of institutional responsibility in crisis situations
5. I acknowledge that the responsibility for acting upon crisis management guidance rests with me and/or my caregiver/nominated representative
6. I understand my rights and responsibilities as a client
7. I consent to the provision of consultation services under these Terms
8. I understand that I may seek clarification on any aspect of these Terms before signing

For Hospital Use Only: This document has been prepared in compliance with the Mental Healthcare Act, 2017, RCI Code of Ethics, & applicable Indian laws. For any clarifications, please contact the Hospital administration.

SERVICE DELIVERY POLICY

• Data Retention & Deletion: Client records will be retained for 3 years as per professional guidelines. Clients may request access, updates, or deletion of their data unless retention is legally required.
• Initial Consultation/Assessments/Therapy: Before the start of any form of assessment or psychotherapy, the first session involves a consultation wherein the therapist understands the context, the reasons for seeking assessment/therapy, potential barriers, and the psycho-social and medical factors influencing the client’s mental health. This session helps in building rapport, selection of assessment tools, setting therapy goals, and formulating an appropriate intervention plan tailored to the client's needs. The clinical assessments or the therapeutic process starts from 2nd session onwards.

Upon formal request of credible insurance providers: the following information may be shared-requested includes description of impairments, dates and times of service, diagnosis, treatment plans, treatment progress, and prognosis for improvement, case notes and summaries.

Definitions

• Minor: Any individual under the age of 18 years.
• Adult: An individual aged 18 years and above.
• Incapacitated Client: A client who is unable to make informed decisions due to mental or physical conditions.
• Nominated Representative: A person appointed by the client for decision-making support and emergency contact, as per MHCA 2017.
• Crisis: Any situation posing imminent danger to the client or others (e.g., suicide risk, severe dissociation, psychosis).
• Teleconsultation: Mental health services provided using electronic communication (video, audio, or text-based).

Supervision and Recording Consent (Addendum)

I consent / do not consent to supervision of my therapy sessions (case details anonymized for discussion purposes). I consent / do not consent to audio/video recording of sessions, if applicable, for training and supervision. I understand that my identity will be protected.

Language Accessibility

This document is available in Hindi or other regional languages upon request to ensure understanding and access for all clients.