Free telehealth policy template
A telehealth policy should cover who may receive telehealth, licensure and client location, informed consent, an emergency plan, identity verification, privacy and security, technology problems, documentation, billing, and training. The template below gives a behavioral health practice a starting point for each section. Edit every section so it describes what your staff actually do, then date and version it.
What is the purpose of a telehealth policy?
This policy describes how our organization delivers behavioral health services by telehealth and how we protect client safety, privacy and quality of care.
Who does this policy cover?
This policy applies to all clinicians and staff who provide or support services by video or phone.
Who may receive telehealth?
Clients may receive telehealth services when it is clinically appropriate, the client agrees, and the clinician is authorized to practice where the client is located. The clinician decides at intake and reviews suitability as care continues.
How do you handle licensure and location?
- At the start of each session, the clinician confirms the client's physical location.
- Clinicians provide services only in states where they hold a license or are otherwise authorized.
- The clinician records the client's location in the note.
What goes in telehealth informed consent?
Before the first session, the client receives and signs a telehealth consent that explains benefits, risks, technology limits, privacy, fees and emergency procedures.
What belongs in the emergency plan?
- Before the first session, we collect the client's current address and an emergency contact.
- If a client is in immediate danger, the clinician follows our crisis procedure, which may include contacting emergency services at the client's location and the emergency contact.
- Clients are told to call or text 988 or call 911 in an emergency.
How do you verify identity?
The clinician confirms the client's identity at the start of care and whenever there is doubt.
How do you protect privacy and security?
- Sessions use approved platforms covered by a business associate agreement.
- Clinicians conduct sessions from a private space and use secure networks.
- Sessions are not recorded unless the client and clinician have agreed in writing and the law allows it.
- Staff do not use personal accounts for client communication.
What happens when technology fails?
If the connection fails, the clinician tries to reconnect and then calls the client by phone. The note records what happened.
What should telehealth documentation include?
Telehealth notes record that the session was by telehealth, the modality, the client's and clinician's locations and any technical problems.
How is telehealth billed?
Telehealth is billed according to each payer's rules, including place of service codes and modifiers. Billing staff review payer policies at least annually.
How often do you train and review?
Clinicians receive telehealth training at hire. This policy is reviewed at least yearly and whenever state law, payer rules or our platform change.
How do you adapt this template?
Add state-specific consent wording, remove sections that do not apply, and name the roles responsible for each task. Place this policy next to the rest of your behavioral health policies and procedures list, and check the Joint Commission and CARF written policies crosswalk if you are preparing for a survey.
How Binder helps
Binder offers full behavioral health policy manuals by level of care and state. Download a free sample policy.
General information only, not legal advice. Confirm with your state board, payers and counsel. Outline checked October 2026.