Privacy of your personal information is an important part of our office to provide you with quality care. We understand the importance of protecting your personal information. We are committed to collecting, using, disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information. It is important to provide this service to our patients.
In this office, Dr. Syed Rahman is the Privacy information Officer.
All staff members who come in contact with your personal information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate use and protection of your information.
In this consent form we have outlined what our office is doing to ensure that; Only necessary information is collected about you; We only share your information with your consent; Storage, retention and destruction of your personal information complies with existing legislation and privacy protocols; Our privacy protocols comply with privacy legislation, standards of our regulatory body, The Royal College of Dental Surgeons of Ontario, and the law. Do not hesitate to discuss our policies with Dr. Rahman or any member of our office staff. Please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.
This office will collect, use, disclose information about you for the following purposes:
Our office understand the importance of protecting your personal information. To help you understand how we are doing that, we have outlined here how our office is using and disclosing your information.
To deliver safe efficient patient care; To identify and the ensure continuous high quality care; To access your health needs; To provide health care; To advise you of treatment options; To enable us to contact you; To establish and maintain communication with you; To offer and provide treatment, care and services in relationship to the oral and maxillofacial complex and dental care generally; To communicate with other healthcare providers, including specialists and general dentists who are the referring dentists and/or peripheral dentists; To allow us to maintain communication and contact with you to distribute oral healthcare information, and to book and confirm appointment; To allow us to efficiently followup for treatment, care and billing; To complete and submit dental claims for third party adjudication and payments; To comply with legal and regulatory requirements, including the delivery of patients’ charts and records to governing bodies in a timely fashion when required according to the provisions of the Regulated Health Professionals Act; To comply with agreement/undertakings entered into voluntarily by the member with the Royal College of Dental Surgeons of Ontario, including the delivery and/or review of patient’s charts and records to the College in a timely fashion for regulatory and monitoring purposes; To permit potential purchasers, brokers or advisors to evaluate the practice; To allow potential purchasers, practice brokers or advisors to conduct an audit in preparation for a practice sale, To delivery your charts and records to the office’s insurance carrier to enable the insurance company to assess liability and quantify damages if any; To prepare materials for the Health Professions Appeal and Review Board (HPARB); To invoice for goods and services; To process credit card and debit payments; To collect unpaid accounts; To assist the office to comply with all regulatory requirements.
By signing this patient consent form, you have agreed that you have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed. If a new purpose arises for the use and/or disclosure of your information, we will seek your approval in advance. Your information may be accessed by regulatory authorities under the terms of the Regulated Health Professionals Act (RHPA) for the purposes of the Royal College of Dental Surgeons of Ontario fulfilling its mandate under the RHPA, and for the defence of a legal issue.
Our office will not, under any conditions, supply your insurer with your confidential medical history. In the event this kind of request is made, we will forward the information directly to you for review and consent. When unusual requests are received, we will contact you for permission to release such information. We may also advise you if such a release is inappropriate. You may withdraw your consent for use or disclosure of your personal information and we will explain the ramifications of that decision and process.
I have reviewed the above information that explains how your office will use my personal information and the steps your office is taking to protect my information. I know that your office has a privacy code and I can ask to see the code at any time.