PRIVACY POLICY
Written Statement of Information Practices and Notice Of Purposes
Our office understands the importance of protecting your personal health information. To help you understand how we are doing that, we have outlined below how our office is collecting, using and disclosing your personal health information. This office will collect, use and disclose information about you for the following purposes:
• To assess your health needs and provide safe and efficient dental care.
• To enable us to contact and maintain communication with you to distribute health care information and to book and confirm appointments.
• To communicate with other treating health care providers, including other dentists, physicians, pharmacists and lab technicians.
• 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.
• To deliver your charts and records to the dentist’s insurance carrier to enable the insurance company to assess liability and quantify damages, as necessary.
• To invoice for goods and services.
• To process credit card payments.
• To collect unpaid accounts.
Please note that any questions or concerns that you might have about your personal health information can be directed to our contact person,Dr. Prasad Satyanarayana Devi
Phone: 905-294-0123
Email: info@sundentalcare.ca
Mailing Address: 70-30 Karachi Drive, Markham, ON, L3S 0B6
Any requests for access or correction to your personal health information should be directed, in writing, to Dr. Prasad Satyanarayana Devi
If you are dissatisfied with the manner in which we have addressed your requests for access or correction to your personal health information or if you have general concerns about our privacy practices, you may contact the Office of the Privacy Commissioner of Ontario by:
SURFACE MAIL Information and Privacy Commissioner/Ontario
2 Bloor Street East
Suite 1400
Toronto, Ontario M4W 1A8
E-mail: info@ipc.on.ca
Phone: Toronto Area (416/local 905): 416-326-3333
Long Distance: 1-800-387-0073 (within Ontario)
TDD/TTY: 416-325-7539
Fax: 416-325-9195
Thank you for your support and understanding in helping our office comply with all regulatory requirements and generally with the law.
Collection, Use And Disclosure of Personal Health Information
Privacy of your personal health information is an important part of our office providing you with quality dental care. We understand the importance of protecting your personal health information. We are committed to collecting, using and disclosing your personal health information responsibly. We also try to be as open and transparent as possible about the way we handle your personal health information. It is important to us to provide this service to our patients.
In this office, Dr. Prasad Satyanarayana Devi is the contact person for personal health information related matters.
All staff members who come in contact with your personal health information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate uses and protection of your information.
Attached to this consent form, we have outlined what our office 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 health information complies with existing legislation and privacy protection protocols;
• Our privacy protocols comply with privacy legislation, standards of our regulatory body, the Royal College of Dental Surgeons of Ontario, and the law.
Do not hesitate to discuss our policies with me or any member of our office staff.
How Our Office Collects, Uses and Discloses Patients’ Personal Health Information
Our office understands the importance of protecting your personal health 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 personal health 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 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 health care 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 health care 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 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 purchasers, practice brokers or advisors to evaluate he 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
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 health information for the purposes that are listed. If a new purpose arises for the use and/or disclosure of your personal health information, we will seek your approval in advance.
Your personal health information may be accessed by regulatory authorities under the terms of the Regulated Health Professions Act (RHPA) for the purposes of the Royal College of Dental Surgeons of Ontario fulfilling its mandate under the RHPA.
You may withdraw your consent for use or disclosure of your personal health information at any time.
Patient Consent
It is understood that I have reviewed the above information that explains how your office will use my personal health information, and the steps your office is taking to protect my information.
I agree that Dr. Prasad Satyanarayana Devi Dentistry Professional Corporation can collect, use and disclose personal health information about me as set out above in the information the office’s privacy policies. My name and signatures are obtained on the registration form authorizing that I have reviewed the privacy policy explained on your website www.sundentalcare.ca.
Compliance with Ontario’s Personal Health Information Protection Act 18