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Patient Privacy & Personal Health Information Protection
- See also: Library of Privacy and Data-Sharing Resources
- Patient Privacy Brochure from the Information Privacy Commissioner [PDF]
- See also: Privacy tools for AFHTO members, developed in partnership with DDO Law
- Office of the Information and Privacy Commissioner of Ontario
- Personal Health Information Protection Act (PHIPA), 2004, 2017
General Privacy Policies
- Clinical Protocols Re: Privacy – Haileybury [PDF]
- Confidentiality and Privacy Form – South East Toronto FHT [PDF]
- Privacy Plan – Haileybury [PDF]
- Privacy Policies – MOHLTC [downloadable Word document]
- Privacy, Ownership & Disclosure Of Patient Records – PHIPA [downloadable Word document]
- Patient Privacy under PHIPA- Village FHT/Queen West FHO [PDF]
- Pledge of Confidentiality – Haileybury [PDF]
- Privacy Policy – Leamington & Area FHT [PDF]
- Privacy Statement – Leamington & Area FHT [PDF]
- Personal Health Information Protection Procedure Manual – Leamington & Area FHT [PDF]
- Privacy Policy – North Perth FHT [PDF]
- Privacy Safeguards Policy – Village FHT/Queen West FHO [PDF]
- Protecting Your Privacy – Haileybury [PDF]
- Statement of Privacy Practices – Haileybury [PDF]
- Woolwich Community Health Centre Privacy Section of Policy and Procedure Manual [downloadable Word document]
- Note: The Woolwich CHC has offered their privacy policy for use on our website as a sample only. Due to differing governance systems, this example should only be used as a reference on how an agency might construct its own privacy policy.
Breach of Privacy
- Breach of Privacy Policy – North Perth FHT [PDF]
- Breach of Privacy Protocol – Village FHT [PDF]
- Privacy Breach Summary Form – South East Toronto FHT [PDF]
Consent to Disclose
- Consent to Disclose Personal Health Information – Village FHT [PDF]
- Authorization to Disclose – Leamington & Area FHT [PDF]
- Express Consent to Use Personal Health Information – Leamington & Area FHT [PDF]
- Withdrawal of Consent – Leamington & Area FHT [PDF]
Confidentiality Agreements
- Confidentiality agreement – Village FHT [PDF]
- Confidentiality agreement – London FHT [PDF]
- Confidentiality agreement – West Champlain FHT [PDF]
- Non-Disclosure agreement – West Champlain FHT [PDF]
- Confidentiality agreement – Leamington & Area FHT [PDF]
Email Consent Forms
EMR & Computer Security
- Computer Security of Confidential Records – Clinton [downloadable Word document]
- Computer Use Guidelines Policy – Clinton [downloadable Word document]
- EMR-Cyber Privacy & Security Agreement – West Champlain FHT [PDF]
- Internet E-mail Policy – Sunset Country FHT [PDF]
- Privacy and eHealth One Pager – Leamington & Area FHT [PDF]
- ClinicalConnect Privacy and Security – Leamington & Area FHT [PDF]
Patient Access to Health Records
- Access to Health Records Policy – Village FHT/Queen West FHO [PDF]
- Request to Access Personal Health Information – Leamington Area FHT [PDF]
Corrections to Personal Health Information
- Request to Correct Personal Health Information – Leamington & Area FHT [PDF]
- Request for Extension of Correction to Personal Health Information – Leamington & Area FHT [PDF]
- Decline for Request to Correct Personal Health Information – Leamington & Area FHT [PDF]
Return to the Library of Organizational Policies and Procedures.
Data-Sharing Agreements
- Memorandum of Understanding for Clinical Data Use – North York FHT
- Physician Application for Professional Staff Status – Georgian Bay (includes data-sharing contract) [downloadable Word document]
Patient Rights & Responsibilities
Return to the Library of Organizational Policies and Procedures.
Accessibility for Patients with Disabilities
- Accessibility Policy – Sunset Country FHT [PDF]
- Accessible Customer Service – North Perth FHT [PDF]
- Presentation: Customer Service Accessibility Standards – Guelph FHT [downloadable PowerPoint file]
- Accessibility Standards for Customer Service Policy – Guelph FHT [downloadable Word document]
- Poster: Accessible Customer Service Plan – Guelph FHT [downloadable Word document]
- Accessibility Policy – SETFHT [PDF]
Return to the Library of Organizational Policies and Procedures.
Anti-Discrimination, Anti-Harassment, and Anti-Abuse Policies
- Anti-harassment – Guelph [downloadable Word document]
- Freedom from Abuse – Peterborough [downloadable Word document]
- Patient Abuse Policy – Clinton [downloadable Word document]
- Workplace Harassment and Discrimination Policy – Clinton [downloadable Word document]
Return to the Library of Organizational Policies and Procedures.
Patient Complaint and Dispute Resolution Policies
- Patient Complaint and Feedback Policy – Village FHT [page on Village FHT’s website]
- Dispute Resolution – Clinton [downloadable Word document]
- Dispute Resolution Incident Form – Clinton [downloadable Word document]
- Resolution of Concerns – Peterborough [downloadable Word document]
- Complaint Management Policy – Clinton [downloadable Word document]
Return to the Library of Organizational Policies and Procedures.
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