We understand the importance of protecting your personal information. We are committed to collecting, using and disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information. It is important to us to provide this service to our patients.
In the dental office of Dr.Ilyas Ahmed & Associates, Dr. Ahmed acts as the Privacy Information Officer. All staff members who come across with your personal 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 about you is collected • We only share information with your consent
- Storage, retention and destruction of your personal information complies with existing legislation and privacy protection protocols Please do not hesitate to discuss our policies with myself or any staff member.
This Dental Office will collect, use and disclose information about you for the following purposes:
- To deliver safe and efficient patient care
- To identify and ensure continuous high-quality service
- To assess your health needs and provide health care
- To advise you of treatment options
- To enable us to contact you and maintain communication with you, including distributing healthcare information and to book and confirm appointments
- 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 physicians, pharmacists, referring general dentists and specialists
- To allow us to efficiently follow up for treatment, care and billing
- For teaching and demonstration on an anonymous basis using photographs of teeth
- To complete and submit dental claims for third party adjudication and payment
- To comply with legal and regulatory requirements, including the delivery of patient's charts and records to the Royal College of Dental Surgeons of Ontario and/or the College of Dental Hygienists 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 Dentist and staff with the Royal College of Dental Surgeons of Ontario and/or the College of Dental Hygienists of Ontario including the delivery and/or review of patient's charts and records to the college(s) in a timely fashion for regulatory and monitoring purposes
- To permit potential purchasers, practice brokers or advisors to evaluate the practice and potentially allow such people to conduct an audit in preparation for a practice sale
- To deliver your charts and records to the staff of insurance carriers to enable the insurance company to assess liability and quantify damages if any To prepare materials for the Health Professions Appeal and Review Board (HPARE)
- 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 reading the consent sections 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 request your verbal and/ or written approval in advance.
- Your 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 and/ or the College of Dental Hygienists of Ontario fulfilling its mandate under the RHPA, and for the defense of a legal issue.
- Our office will not supply your insurance company with your confidential medical history information. If such a request is made, we will obtain specific request from you to forward such information along.
- 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 and disclosure of your personal information, and we will explain the ramifications of that decision, and the process.
