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 diagnosis. 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 email or 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 a Registered Social Worker (RSW) or a supervised Social Work 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 10 years for staff to refer to.

Information we keep on file may include the following:

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

ASWW operates as a team where all staff and student interns are ethically bound by confidentiality. Information is only shared where it is found to be clinically necessary and helpful in providing service to you.

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 at Home, 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

One 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).

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

At the Alzheimer Society Waterloo Wellington, 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 electronic email communications. 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 electronic 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 electronic email communications include, but are not limited to, the following:

• The privacy and security of electronic 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
• Electronic email communications can be forwarded, intercepted, circulated, stored or even changed without the knowledge or permission of the physician or the patient. 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
• Use of email to discuss sensitive information can increase the risk of such information being disclosed to third parties
• Email can be used as evidence in court
• Despite reasonable efforts to protect the privacy and security of electronic 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 the Terms of Service found in the Alzheimer Society of Waterloo Wellington Program Guide and/or the other side of this document.

Questions or concerns about our Electronic 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. 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).