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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:
- To deliver safe and efficient patient care
- To identify and to ensure continuous high quality
service
- To assess your health needs
- To provide health care
- To advise 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 health-care
providers, including specialists and general dentists who are
the referring dentists and/or peripheral dentists
- To allow us to obtain communication and contact
with you to distribute health-care information and to book and
confirm appointments
- To allow us to efficiently follow-up for treatments,
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 patients’ charts and records to the
Royal College of Dental Surgeons of Ontario 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 purchases, practice brokers
or advisors to evaluate the dental practice
- To allow potential purchases, 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
By signing the consent section of 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
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 advance.
Your information may be accessed by regulatory authorities
under the terms of the Regulated Health Professions Act (RHAP) for
the purpose of the Royal College of Dental Surgeon of Ontario fulfilling
its mandate under the RHAP, and for the defense of a legal issue.
Our office will not under any conditions supply your
insurer with your confidential medical history. In the event 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.
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