Lotus

General Consent to the Collection, Use, and Disclosure of Personal Health 

Information

Our team strives to provide quality care and we collect, use, disclose, retain, and dispose of your personal information in compliance with federal and provincial privacy legislation and applicable college regulations. We will be as open and transparent as possible about the way we handle your personal health information.

All staff members who come in contact with your personal health information have signed a confidentiality form and are aware of the sensitive nature of this information. If you have any questions or complaints regarding how our clinic manages your personal information, we request that you contact us.

Our Privacy Policy Outlines What Our Clinic 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 provincial and federal legislation, college regulations, and privacy protection protocols

How Our Clinic Uses and Discloses Patients’ Personal Information:

• To assess your health concerns, advise you of options, and provide healthcare

• To establish and maintain contact with you

• To communicate with other treating care providers

• To allow us to efficiently follow-up for treatment, care, and billing via phone, email, mail, and voicemail

• To invoice for goods and services and collect unpaid accounts and process credit card payments

• To comply with the law

• To complete claims for insurance purposes

• To contact you occasionally about changes to services, special offers, updates, and other opportunities

Access To Your Personal Health Records:

You can access and correct your personal health records or withdraw your consent for some of its uses and disclosures by contacting us (this may be subject to certain legal exceptions).

Consent Statement (To Be Signed And Given to Physician)

On your first visit, you will be asked to sign our Patient Consent Form which will include the following statement from you:

“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 as outlined above. I have reviewed the above information and understand how MDs at Queensway will use my personal information and the steps our clinic is taking to protect my information. I agree that MDs at Queensway can collect, use, and disclose personal information as set out above.”