Jeff M Robichaud Medicine Professional Corporation
23 Hannover Drive Unit #5
St. Catharines, Ontario
L2W 1A3, Canada
This policy outlines how we protect the privacy of your personal information and medical record. Everyone working for this office is required to adhere to the protections described in this policy. If you have any questions regarding our privacy practices, please contact your doctor or one of our staff.
Collection, Use and Disclosure of Personal Information
What personal information do we collect?
We collect the following personal information:
- Identification and Contact information (name, address, date of birth, emergency contact, etc)
- Billing information (provincial plan and/or private insurer)
- Health information (symptoms, diagnosis, medical history, test results, reports and treatment, record of allergies, prescriptions, etc)
When and to whom do we disclose personal information?
Implied consent for provision of care: By virtue of seeking care from us, your consent is implied (i.e., assumed) for your information to be used by this office to provide you with care, and to share with other providers involved in your care.
Disclosure to other health care providers:
Relevant health information is shared with other providers involved in your care, including (but not limited to) other physicians and specialists, pharmacists, lab technicians, physiotherapists, occupational therapists.
Disclosures authorized by law:
There are limited situations where we are legally required to disclose your personal information without your consent. These situations include (but are not limited to) billing provincial health plans, reporting infectious diseases and fitness to drive, or by court order.
Disclosures to all other parties:
Your express consent is required before we will disclose your information to third parties for any purpose other than to provide you with care or unless we are authorized to do so by law. Examples of disclosures to other parties requiring your express consent include (but are not limited to) third party medical examinations, provision of charts or chart summaries to insurance companies, enrollment in research studies and trials.
Can you withdraw consent?
You can withdraw your consent to have your information shared other health care providers or other parties at any time, except where the disclosure is authorized by law. However, please discuss this with your physician first.
How do you access the personal information held by this office?
You have the right to access your record in a timely manner. If you request a copy of your record, one will be provided to you at a reasonable cost. If you wish to view the original record, one of our staff must be present to maintain the integrity of the record, and a reasonable fee may be charged for this access. Patient requests for access to the medical record can be made verbally, in writing, directed to the physician, directed to any office staff.
Limitations on access
In extremely limited circumstances you may be denied access to your records, but only if providing access would create a significant risk to you or to another person.
What if you feel your record is not accurate?
We make every effort to ensure that all of your information is recorded accurately. If an inaccuracy is identified, you can request that a note be made to reflect this on your file.
What is our communications policy?
We protect personal information regardless of the format. Specific procedures are in place for communicating by phone, email, fax, and post/courier.
How long do we keep information?
We retain patient records as required by law and professional regulations.
If you believe that this office has not replied to your access request or has not handled your personal information in a reasonable manner, please address your concerns first with your doctor.
Your may also choose to make a complaint to
- Provincial/territorial college
- Provincial/territorial privacy commissioner
- Federal privacy commissioner
(Physician) Signature: ________________________________________
This policy was created with the help of the CMA PRIVACYWIZARD™