In today’s world, it is common for a spouse or partner to arrange appointments for their family members, or for a parent or guardian to assist with the health care needs of adult family members. However, it is not permissible for a spouse to act on their spouse’s behalf, or a parent/guardian on behalf of a patient 16 and over, unless authorized.
Pursuant to the Personal Health Information Act, 2004 (PHIPA), the form below is for the purpose of authorizing someone other than yourself to communicate with our staff with regard to your medical information (see page 2 for details). This form can be completed at your convenience and the original submitted at either the Erin or Rockwood clinic. Please note that you may be contacted to verify the authenticity of your consent if someone, other than yourself, delivers this form.
Alternatively, you may contact us by phone (Reception: (613) 544-3242) and ask that your verbal consent be documented in your chart. If you choose the phone-in option, staff will explain to you what your consent means and how it will be carried out.
If you have given us permission to share your health information with someone, i.e. family or friend, please know that this consent remains in your chart until you instruct us otherwise. If you would like to remove this permission, please speak with your doctor or reception staff.
Should a breach of any of these responsibilities occur, depending on the severity of the actions, any or all of the following may be carried out:
As a patient, you have the right to:
Providing Feedback:
We ask patients or families who have problems, complaints or concerns to follow the process described below. These steps ensure patients first seek assistance from staff members who are most familiar with their care, and who can provide additional options if needed:
Protecting your privacy and the confidentiality of your personal information has always been an important aspect of the Kingston Heart Clinic (KHC) operations. The appropriate collection, use, and disclosure of patients’ personal health information are fundamental to our day-to-day operations and to your care. We strive to provide you with excellent medical care and service, which includes treating your personal information with respect. Each member and employee of the practice must abide by our commitment to privacy in the handling of personal information.
Applicability of This Privacy Policy
Our Privacy Policy informs you of our commitment to privacy and tells you the ways we ensure that your privacy is protected. Our Privacy Policy applies to protect the personal health information of all our patients that are in our possession and control.
What is Personal Health Information?
Personal health information means identifying information about an individual relating to their physical or mental health (including medical history), the providing of health care to the individual, payments or eligibility for health care, organ and tissue donation and health number.
The 10 Principles of Privacy
Our Privacy Policy reflects our compliance with fair information practices, applicable laws and standards of practice.
1. Accountability
We take our commitment to securing your privacy very seriously. Each physician and employee associated with the KHC is responsible for the personal information under his/her control. Our employees are informed about the importance of privacy and receive information periodically to update them about our Privacy Policy and related issues.
2. Identifying Purposes: Why We Collect Information
We ask you for information to establish a relationship and serve your medical needs. We obtain most of our information about you directly from you, or from other health practitioners whom you have seen and authorized to disclose to us. You are entitled to know how we use your information and this is described in the Privacy Statement posted at the end of this document. We will limit the information we collect to what we need for those purposes, and we will use it only for those purposes. We will obtain your consent if we wish to use your information for any other purpose.
3. Consent
You have the right to determine how your personal health information is used and disclosed. For most health care purposes, your consent is implied as a result of your consent to treatment, however, in some circumstances your express, sometimes written, consent may be required.
4. Limiting Collection
We collect information by fair and lawful means and collect only that information which may be necessary for purposes related to the provision of your medical care.
5. Limiting Use, Disclosure, and Retention
The information we request from you is used for the purposes defined. We will seek your consent before using the information for purposes beyond the scope of the posted Privacy Statement. Under no circumstances do we sell patient lists or other personal information to third parties. There are some types of disclosure of your personal health information that may occur as part of the KHC fulfilling its routine obligations and/or clinical management. This includes consultants and suppliers to the Practice, on the understanding that they abide by our Privacy Policy, and only to the extent necessary to allow them to provide business services or support to this Practice. We will retain your information only for the time it is required for the purposes we describe and once your personal information is no longer required, it will be destroyed. However, due to our ongoing exposure to potential claims, some information is kept for a longer period. Medical records are kept for at least 10 years.
6. Accuracy
We endeavor to ensure that all decisions involving your personal information are based on accurate and timely information. While we will do our best to base our decisions on accurate information, we rely on you to disclose all material information and to inform us of any relevant changes.
7. Safeguards: Protecting Your Information
We protect your information with appropriate safeguards and security measures. The KHC maintains personal information in a combination of paper and electronic files. Recent paper records concerning individuals’ personal information are stored in files kept onsite. Access to personal information will be authorized only for the physicians and employees associated with the KHC, and other agents who require access in the performance of their duties, and to those otherwise authorized by law. We provide information to health care providers acting on your behalf, on the understanding that they are also bound by law and ethics to safeguard your privacy. Other organizations and agents must agree to abide by our Privacy Policy and may be asked to sign contracts to that effect. We will give them only the information necessary to perform the services for which they are engaged, and will require that they not store, use or disclose the information for purposes other than to carry out those services. Our computer systems are password-secured and constructed in such a way that only authorized individuals can access secure systems and databases. If you send us an e-mail message that includes personal information, such as your name included in the “address”, we will use that information to respond to your inquiry. Please remember that e-mail is not necessarily secure against interception. If your communication is very sensitive, you should not send it electronically unless the e-mail is encrypted or your browser indicates that the access is secure.
8. Openness: Keeping You Informed
The KHC has prepared this plain-language Privacy Policy to keep you informed. You may ask to receive a copy of it from any of the front desk receptionists. If you have any additional questions or concerns about privacy, we invite you to contact us and we will address your concerns to the best of our ability.
9. Access and Correction
With limited exceptions, we will give you access to the information we retain about you within a reasonable time, upon presentation of a written request and satisfactory identification. We may charge you a fee for this service and if so, we will give you notice in advance of processing your request. If you find errors of fact in your personal health information, please notify us as soon as possible and we will make the appropriate corrections. We are not required to correct information relating to clinical observations or opinions made in good faith. You have a right to append a short statement of disagreement to your record if we refuse to make a requested change. If we deny your request for access to your personal information, we will advise you in writing of the reason for the refusal and you may then challenge our decision.
10. Challenging Compliance
We encourage you to contact us with any questions or concerns you might have about your privacy or our Privacy Policy. We will investigate and respond to your concerns about any aspect of our handling of your information. In most cases, an issue is resolved simply by telling us about it and discussing it. If, after contacting us, you feel that your concerns have not been addressed to your satisfaction, we will provide information on other complaint procedures that may be available to you.
Conclusion
Any changes to our Privacy Policy shall be acknowledged in this Privacy Policy in a timely manner.
