Zajacz Dental Centre Brockville

To deliver safe and efficient patient care
To identify and ensure continuous high quality service
To assess 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 treating 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 healthcare information and to book and confirm appointments
To allow us to efficiently follow-up for treatment, care and billing
For teaching and demonstrating purposes on an anonymous basis
To complete and submit dental claims for third party adjudication and payment
To comply with legal and regulatory requirements, including the delivery of patients charts and records to the College in a timely fashion, when required according to the provisions of the Regulated Health Professions Act
To comply with agreements/undertakings entered into voluntarily by the member with the Royal College of Dental Surgeons of Ontario, including the delivery and/or review of patients charts and records to the College in a timely fashion for regulatory and monitoring purposes
To permit potential purchasers, practice brokers or advisors to evaluate the dental practice
To allow potential purchasers, practice brokers or advisors to conduct an audit in preparation for a practice sale
To deliver your charts and records to the dentist'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 payments
To collect unpaid accounts
To assist this office to comply with all regulatory requirements
To comply generally with the law

This office will identify the purposes for which personal information is collected at or before the time of collection. We will only collect that information necessary for the identified purposes.

When personal information has been collected and is to be used or disclosed for a purpose not previously identified, the purpose will be identified prior to its use or the disclosure. Your consent is required before the information can be used or disclosed for that purpose.

Office staff collecting personal information will be able to explain to you the purpose for which the information is being collected.

When you sign the Patient Consent Form, you will be deemed to understand and accept this office's collection, use and disclosure of your information for the specified purposes.

Principle 3: Consent
This office will seek informed consent for the collection, use and/or disclosure of personal information, except where it might be inappropriate to obtain your consent, and subject to some exceptions set out in law.

Consent is required for the collection of personal information and subsequent use or disclosure of that information.

In order for the principles of consent to be satisfied, our office has undertaken reasonable efforts to ensure that you are advised of the purposes for which information is being used, and that you understand those purposes. Once consent is obtained, we do not need to seek your consent again, unless the use, purpose or disclosure changes.

Existing protocols for electronic submissions of dental claims require a signature on file. Specific consent may be required for additional requests from insurers. This shall be collected at the time, or in conjunction, with predeterminations for extensive services, providing the scope of information released is disclosed. If there is any doubt, information shall be released directly to you for review and submission.

Consent for the collection, use and disclosure of personal information may be given in a number of ways, such as:

Signed medical history form;
Signed introductory questionnaire;
Taken verbally over the telephone and then charted;
Email;
Written correspondence.

You may withdraw consent upon reasonable notice.

Principle 4: Limiting Collection of Personal Information
The collection of personal information by our office shall be limited to that which is necessary for the purposes identified in this Privacy Code.

Principle 5: Limiting Use, Disclosure and Retention
Personal information shall not be used or disclosed for purposes other than those for which the information is collected, except with your express consent, or as required by law.

Our office has protocols in place for the retention of personal information.

Retention of information records is defined and referenced in College's Guidelines on Dental Record Keeping.

In destroying personal information, our office has developed guidelines to ensure secure destruction in accordance with the College's Guidelines on Dental Record Keeping.

Principle 6: Accuracy of Personal Information
This office endeavours to ensure that your personal information is accurate, complete, and as up-to-date as necessary for the purposes that it is to be used.

The extent to which your personal information shall be accurate, complete and up-to-date will depend upon the use of the information, taking into account the interest of our patients.

Information shall be sufficiently accurate, complete and up-to-date to minimize the possibility that inappropriate information is used to make a decision about you as our patient.

Principle 7: Safeguards for Personal Information
Our office has taken appropriate measures to safeguard your personal information from unauthorized access, disclosure, use or tampering.

Safeguards are in place to protect your personal information against loss or theft, as well as unauthorized access, disclosure, copying, use or modification.

Your information is protected, whether recorded on paper or electronically.

Our office staff is aware of the importance of maintaining the confidentiality of personal information.

Care is used in the care and destruction of personal information to prevent unauthorized access to the information even during disposal and destruction.

Principle 8: Openness about Privacy
Our office will make readily available to you specific information about our office policies and practices relating to the management of personal information.

This information includes:

A Patient Information Sheet that outlines the name of the Privacy Information Officer who is accountable for our office privacy policies. This is the person to whom you can direct any questions or complaints. The information sheet also describes how to access your personal information held in this office;
A copy of our patient consent form that explains how this office collects, uses and discloses your personal information;
Our office Privacy Code

Principle 9: Patient Access to Personal Information
Upon written request and with reasonable notice, you shall be informed of the existence, use and disclosure of your personal information, and shall be given access to that information.

Upon written request and with reasonable notice, our office will advise you whether or not we hold personal information about you.

Our office shall allow you access to this information.

Upon written request and with reasonable notice, our office shall provide you with an accounting of how your personal information has been used, including third party disclosures. In providing this information, we will attempt to be as specific as possible.

When it is not possible to provide a list of the organizations or individuals to which there has been disclosure about you, we will provide you with a list of such organizations or individuals to which we may have disclosed information about you. Disclosure of probabilities in these cases would satisfy this requirement.

We will respond to your request within a reasonable period of time, and at minimal or no cost to you. The request for information will be provided or made available in a form that is generally understandable.

The dentist will comply with the regulations of his/her College that define patient access to records.

You are free to challenge the accuracy and completeness of the information and seek to have it altered, amended, or changed. This process is explained in the Patient Information Sheet.

When a challenge is not resolved to your satisfaction, we will record the substance of the unresolved challenge.

When appropriate, the existence of the unresolved challenge shall be transmitted to third parties having access to the information in question. This disclosure may be appropriate where a dentist has been challenged about a change to a service date or services rendered under consideration for insurance benefits.

Principle 10: Challenging Compliance
You shall be able to challenge compliance with these principles with the office's Privacy Information Officer who is accountable within the dental office for the dentist's compliance. Our office has in place procedures to receive and respond to your complaints or inquiries.

This information including the name of our office's Privacy Information Officer, is included in the Patient Information Sheet, available on request.

The procedure is easily accessible and simple to use.

Our office has an obligation to inform our patients who make inquiries about how to access the privacy complaint process in our office, and about how to access that process.

This information is outlined in the Patient Information Sheet.

The Privacy Information Officer in our office will investigate each and every complaint made to the office in writing.

If a complaint is found to be justified, the Privacy Information Officer will take appropriate measures, including if necessary, amending any office policies and practices.

Patients will be provided with information about how to contact the Privacy Commissioner of Canada to forward any unresolved complaint. This information is included in the Patient Information Sheet, available on request.