ASWW New Client Registration

YOUR INFORMATION AND RECORDS

The staff of the Alzheimer Society Waterloo Wellington (ASWW) are required to keep records of the services we provide and the conversations that we have with you. We refer to these notes so we can recall information to best support you.

A law passed by the Ontario government in 2004 called Personal Health Information Protection Act gives health care providers rules to follow for handling the information we record about you, which is called personal health information. 

In addition, staff, professional placement students, and volunteers of ASWW all sign confidentiality agreements prior to beginning their work.

SHARING YOUR INFORMATION WITHOUT PERMISSION

There are circumstances in which staff members are legally allowed (and may be legally required) to share your personal health information without your permission.

These circumstances include

1. Medical emergencies

2. Situations which staff are served with a search warrant or subpoena requiring release of your information to legal authorities.

3. Staff may also share your personal health information if the information you provide gives them reasonable grounds to suspect that you will harm yourself or situations of abuse has occured.

YOUR RIGHTS

Under the Personal Health Information Protection Act (PHIPA) you have the following rights:

• To see and correct your information on file with ASWW
• To make a complaint about the handling of your personal information by ASWW

YOUR CIRCLE OF CARE

Your health information may be shared with, or collected from, members of your circle of care. The "cirlce of care" refers to individuals and organizations who provide services to you. This may include doctors, hospitals, Ontario Health at Home and day program providers.

You may tell us that you can do not want us to share information with certain members of your circle of care. We require your permission (verbal or written) to share your personal information with any person or organization outside your circle of care.

PROTECTING YOUR INFORMATION

Your health information will only be collected, used, and shared for the purpose of meeting your health and service needs. This information will be accessed by only the relevant staff, professional placement students, and trained volunteers of ASWW who are providing services to you. 

Information collected about you is stored in a secure computer database indefinitely. ASWW also has a privacy policy to protect the confidentiality of your information, which you are welcome to review.

Demographic and statistical information will also be used by ASWW for service planning and management.

COMPLAINTS

You may contact the privacy officer for ASWW for more information or to make a complaint. You can do so by contacting our offices.

You may also forward complaints about the handling of your information to the Information and Privacy Commissioner of Ontario (IPC). 

The IPC can be reached by the following methods:

MAIL

1400-2 Bloor Street East, Toronto, Ontario M4W 1A8

PHONE

1-800-387-0073

WEBSITE

www.ipc.on.ca

The Alzheimer Society Waterloo Wellington’s (ASWW) role is to support persons living with dementia/cognitive impairments and their care partners in living well with a dementia/cognitive impairment. Our programs and services include support and education groups, counselling, care coordination, and social/recreational opportunities. These programs may be offered in-person, by phone or virtually through video conferencing. Please note that we are using online technology that helps us connect with you. Privacy measures put in place by these technologies will protect your privacy. Despite reasonable efforts to safeguard the confidentiality and security of electronic and virtual communications, it is only possible to partially secure the information.Our programs help people remain supported and engaged throughout the dementia/cognitive impairment journey. Some French language services are available upon request.

All personal information is protected by confidentiality. A confidential file will be created by an ASWW staff member who may be a Registered Social Worker (RSW) or a Registered Nurse (RN) or Registered Practical Nurse (RPN) or student intern during your initial intake appointment. We will securely keep your file in our electronic database per the Personal Health Information Protection Act, 2004 (PHIPA). All paper records will be held for at least ten years for staff to refer to. Information we keep on file may include thefollowing:

• The services you receive from us and the dates we provided them to you
• Demographic and statistical data
• Information about you and your situation that is necessary to understand your service needs

Your health information may be shared with or collected from your ‘circle of care.’ The circle of care refers to individuals and organizations who provide services to you. This may include: doctors, hospitals, Ontario Health atHome, day program providers and community support services. You can tell us if you do not want us to share information with certain members of your circle. You may also permit us, verbally or in writing, to share your personal information with any individual or organization outside of your circle of care.

Exceptions to confidentiality in which staff members must report or are required to share your personal health information without your permission include some of the following examples:

1. Medical emergencies
2. Court-order
3. If we believe you or someone you know is at risk of or experiencing harm to self or others
4. If a child under the age of 16 could be at risk
5. Professional misconduct in the form of abuse or behaviour that has placed you or someone you know at risk

You can discuss questions or concerns about our Terms of Service with an ASWW staff member. Alternatively, you may contact our office and request to speak with ASWW’s privacy officer for more information or to make a complaint by contacting Michelle Martin by email: mmartin@alzheimerww.ca or by calling our offices, ext. 2014. You may also forward complaints about ASWW’s handling of your information to the Information and Privacy Commissioner of Ontario: by phone (1-800-387-0073); or by mail (1400-2 Bloor Street East, Toronto, Ontario, M4W 1A8).

ASWW strives to provide a safe setting for all. Violent, aggressive, threatening, or disruptive conduct is not permitted. Verbal or physical abuse of our staff, students or volunteers will not be tolerated. Thank you for your cooperation.

At ASWW, we welcome people of any age, ability, gender identity and expression, race, colour and sexual orientation.

The Alzheimer Society of Waterloo Wellington (ASWW) offers clients the opportunity to communicate through the use of email communications. Email is used for administrative purposes. This may include scheduling appointments, registering for a program, and/or receiving resources. Counselling or any therapeutic intervention cannot occur over email and can only take place through direct communication between the team member and the client using phone, zoom or in person. You are responsible to reach out to a team member when you need such support. Furthermore, staff will only respond to an email during work hours.

ASWW will use reasonable means to protect the security and confidentiality of electronic information sent and received. However, because of the risks outlined below, ASWW cannot guarantee the security and confidentiality of email communication and will not be liable for improper disclosure of confidential information that is not the direct result of intentional misconduct by ASWW.

The risks of email communications include, but are not limited to, the following:

• The privacy and security of email communication cannot be guaranteed.
• Employers and online services may have a legal right to inspect and keep emails that pass through
  their system.
• Email is easier to falsify than handwritten or signed hard copies. In addition, it is impossible to verify the true identity of the sender, or to ensure that only the recipient can read the email once it has been sent.
• Emails can introduce viruses into a computer system, and potentially damage or disrupt the computer.
• Email communications can be forwarded, intercepted, circulated, stored or even changed without the knowledge or permission of the sender or the receiver. Email senders can easily misaddress an email, resulting in it being sent to many unintended and unknown recipients.
• Email is indelible. Even after the sender and recipient have deleted their copies of the email, back-up copies may exist on a computer or in cyberspace.
• Email can be used as evidence in court.
• Despite reasonable efforts to protect the privacy and security of email communications, it is not possible to completely secure the information.
• Email communication is considered part of the clinical record. Copies of emails between client and ASWW staff may be attached into client file.
• Information provided by client via email is subject to Exceptions to Confidentiality as outlined in ASWW Terms of Service.

By providing ASWW with my email address, implicitly I agree to the use of my email for the purpose of electronic communications with ASWW. Please note, that this document is in addition to ASWW Terms of Service.

Questions or concerns about our Email Communication Terms of Service can be discussed with an ASWW staff member. Alternatively, you may contact our office and request to speak with the ASWW’s Privacy Officer for more information or to make a complaint by contacting Michelle Martin by email:mmartin@alzheimerww.ca or by calling our offices, ext. 2014. You may also forward complaints about ASWW’s handling of your information to the Information and Privacy Commissioner of Ontario: by phone (1-800-387-0073); or by mail (1400-2 Bloor Street East, Toronto, Ontario, M4W 1A8).

Original document was produced by Alzheimer Society of Huron County, adapted from Bridgepoint Family Health team and CMPA

The Alzheimer Society of Waterloo Wellington (ASWW) can provide assessment, follow-up, counselling and care partner group offerings by team members (some maybe registered social workers or other registered health professionals) through phone and video conferencing. Please note that we are using onlinetechnology that helps us connect with you. We believe that privacy measures put in place by these technologies will protect your privacy. Despite reasonable efforts to protect the privacy and security of phone and video sessions, it is not possible to completely secure the information. In addition to understanding this risk, please review the following:

• I agree to download any necessary software in advance of my video session and manage the data usage and any associated costs resulting from video/phone sessions with ASWW staff.
• I agree to choose a location that ensures my privacy during video or phone sessions. I agree to provide/confirm the details of my physical/geographic location and emergency contact information at the beginning of each video or phone session. I am aware of the availability of 911 service and Here 24/7
  support.
• I agree that I will be in the province of Ontario while participating in each video or phone session. If I am traveling outside of Ontario, I understand that I can not participate remotely.
• I will not participate in video or phone sessions while operating a motor vehicle or walking outside the home.
• I understand that ASWW staff reserve the right to terminate the session if confidentiality is not protected due to other individuals entering the session or risk due to driving/walking.
• I agree to not record the video or phone session unless I have discussed an accommodation with an ASWW team member.
• I agree to advise the ASWW staff member of any changes in my mental health or circumstances that might affect my safety while engaging in video or phone session.
• I understand that information provided by myself via video or phone session is subject to Exceptions to
  Confidentiality as outlined in Alzheimer Society of Waterloo Wellington Terms of Service. I understand and consent to the above Terms of Service and give my consent by accepting the phone call or the video session invite and joining the scheduled session with the ASWW
  team member.

Questions or concerns about our Video or Phone Terms of Service can be discussed with an ASWW staff member. Alternatively, you may contact our office and request to speak with the ASWW’s Privacy Officer for more information or to make a complaint. You may also forward complaints about ASWW’s handling of your information to the Information and Privacy Commissioner of Ontario: by phone (1-800-387-0073); or by mail (1400-2 Bloor Street East, Toronto, Ontario, M4W 1A8).