Aspect Hygiene

Information Practices and Personal Health Information

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 deliver safe and efficient patient care

To identify and ensure continuous high-quality care

To assess your health needs and provide safe and efficient dental care

To advise you of treatment options

To enable us to contact and maintain communication with you to distribute health care 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 health care providers, including other dentists, physicians, pharmacists and lab technicians

For teaching and demonstrating purposes on an anonymous basis

To comply with legal and regulatory requirements

To complete and submit dental claims for third party adjudication and payment

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 comply with legal and regulatory requirements, including the delivery of patients’ charts and records to the Royal College of Dental Surgeons of Ontario or 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 the member with the Royal College of Dental Surgeons of Ontario or College of Dental Hygienists of Ontario, including 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 invoice for goods and services

To process credit card payments

To collect unpaid accounts

To comply with a legal warrant

Please note that any questions or concerns that you might have about your personal health information can be directed to our contact person Cara Baines RDH. Any requests for access or correction to your personal health information should be directed, in writing, to Cara Baines RDH

Cara Baines can be reached at:

Telephone: 1-226-664-2229

Address: 890 7th Avenue West, Owen Sound, ON, N4K5K1

If you are dissatisfied with the manner in which we have addressed your requests for access or correction to your personal health information or it 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 Email: info@ipc.on.ca

2 Bloor Street East	Phone:1-416-326-333

Suite 1400	Long Distance: 1-800-387-0073

Toronto, On M4W1A8	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 the law.

Name: Click or tap here to enter text. Signature: ______________________________________________

Date:Click or tap to enter a date.