NOTE: IT IS IMPORTANT THAT ANY CHANGE IN YOUR HEALTH STATUS BE REPORTED TO OUR OFFICE
Our office understands 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.This office will collect, use, and disclose information about you for the following purposes:
By signing the consent section of this Patient Consent Form, you have agreed that you have given your informed consent to this 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 personal information, we will seek your approval in advanceYour information may be accessed by regulatory authorities under the terms of the Regulated Health Professions 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 even this kind of request is made, we will forward the information directly to you for review and for your specific 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 the process.
I have received the above information that explains how your office will use my personal information and the steps yourthe 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. I agree that Humber Valley Dental can collect, use, and disclose Personal information about