Grief and Support Group Registration | Tabitha Hospice Bereavement

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Support Groups

I'm registering for the following group(s):

Unique Dynamics of Grief (Age 25-55)
Remembering Angels - Lincoln
Remembering Angels - York
Men's Coffee Group - Lincoln
Women's Coffee Group - Lincoln
Aurora Grief Support Group
Seward Grief Support Group
Other — I am interested in groups, but can't do this time or location

Please read and consent to the terms of the Support Group

I hereby consent to engaging in grief related group support via Microsoft Teams.

I understand that group support may include the practice of grief support and education using interactive audio, video, or data communications.

I understand the following with respect to Tabitha Support Group:

I understand that there are risks and consequences from distance support groups, including, but not limited to, the possibility, that despite reasonable efforts on the part of the group facilitator, that: the transmission of confidential information could be disrupted or distorted by technical failures. These risks are offset by the use of Teams, a HIPAA-compliant service which is encrypted for video health communications. Further, the contents of my group facilitator’s computer are encrypted.
In addition, I understand that virtual support may not yield the same results nor be as effective as face to-face service.
In emergencies, in the event of disruption of service, or for routine or administrative reasons, it may be necessary to communicate by other means, including telephone or secure email. I understand that non-encrypted email is not secure and should not be used to convey HIPAA protected information.
It is my responsibility to maintain privacy on the group member end of communication. This includes NOT recording support group sessions. It also includes not using the chat/typing feature during sessions.
I understand that there are potential limits and benefits associated with any form of support group despite good intentions. I understand that the support group facilitator may suggest the further support of a licensed professional and that I could ask for a referral if the support group does not seem adequate for my needs.
I acknowledge, however, that if I am facing or if I think I may be facing an emergency situation that could result in harm to me or to another person; I agree to seek care immediately through my own local health care counselor or at the nearest hospital emergency department or by calling 911.