(A platform offered through Main Street Medical Clinic, Springdale, NL)
Purpose: This policy outlines how we protect the privacy of your personal information and medical record. Everyone working for this office is required to adhere to the protections described in this policy. If you have any questions regarding our privacy practices, please contact your email@example.com
Collection, Use and Disclosure of Personal Information
We collect the following personal information:
• Identification and contact information (name, address, date of birth, emergency contact, etc.
• Billing information (provincial plan and/or private insurer)
• Health information (symptoms, diagnosis, medical history, test results, reports and treatment,
When and to whom do we disclose personal information?
• Implied consent for the provision of care: By virtue of seeking care from us, your consent is implied
(i.e., assumed) for your information to be used by this office to provide you with care, and to
share with other providers involved in your care.
• Disclosure to other healthcare providers: Relevant health information is shared with other
providers involved in your care, including (but not limited to) other physicians and specialists,
pharmacists, lab technicians, nutritionists, physiotherapists, occupational therapists.
• Disclosures authorized by law: There are limited situations where we are legally required to
disclose your personal information without your consent. These situations include (but are not
limited to) billing provincial health plans, reporting infectious diseases and fitness to drive, or by
• Disclosures to all other parties: Your express consent is required before we will disclose your
information to third parties for any purpose other than to provide you with care, or unless we are
authorized to do so by law. Examples of disclosures to other parties requiring your express
consent include (but are not limited to) third party medical examinations, provision of charts or
chart summaries to insurance companies, or enrolment in research studies and trials.
Can you withdraw consent?
You can withdraw your consent to have your information shared with other health care providers or other parties at any time, except where the disclosure is authorized by law.
How do you access the personal information held by this office?
You have the right to access your record in a timely manner. If you request a copy of your record, one will be provided to you at a reasonable cost. If you wish to view the original record, one of our staff must be present to maintain the integrity of the record, and a reasonable fee may be charged for this access. Patient requests for access to the medical record can be made verbally, in writing, directed to the physician, or directed to any office staff by emailing firstname.lastname@example.org
• Limitations on access: In extremely limited circumstances you may be denied access to your
records, but only if providing access would create a significant risk to you or to another person.
What if you feel your record is not accurate?
• We make every effort to ensure that all of your information is recorded accurately. If an
inaccuracy is identified, you can request that a note
How long do we keep information?
We retain patient records as required by law and professional regulations.
How do we dispose of information when it is no longer required?
• When information is no longer required, it is destroyed in a secure manner, according to set
procedures that govern the storage and destruction of personal information.
If you believe that
• College of Physicians and Surgeons of Newfoundland and Labrador
• Office of the Information and Privacy Commissioner of NL