PRIVACY POLICY

PATIENT CONSENT FOR COLLECTION, USE & DISCLOSURE OF PERSONAL INFORMATION

Privacy of your personal information has always been an important part of providing you with quality dental care. 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 this office, Dr. Timothy Agapas acts as the Privacy Information Officer.

All staff members who come in contact 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.

We will outline 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 information complies with existing legislation and privacy protocols
our privacy protocols comply with privacy legislation & standards of our regulatory body (the Royal College of Dental Surgeons of Ontario) and the law.

How our office collects, uses and discloses patients’ personal information

Our office understands the importance of protecting your personal information. We only collect what we absolutely need. To help you understand how we are doing that, we have outlined how our office is using and disclosing your information.

This office will collect, use & disclose 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 inform us of patients arrival and their location in the office with the check-in program
to enable pertinent patient information to be accessed at the dental chair
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 other dentists who are the referring dentists 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, lecturing, publishing and demonstrating purposes on an anonymous basis
to complete 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 the practice
to allow potential purchasers, practice brokers or advisors to conduct and 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
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 continued attendance of appointments at our office you are giving your implied consent to the collection, use and/or disclosure of your personal information for the purposes that are listed. Signing of the consent section of this Patient Consent Form gives your explicit 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 seek your 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 fulfilling its mandate under the RHPA, and for the defense of a legal issue.

Our office will not under any conditions supply your insurer with your confidential medical history. In the event this kind of a request is made, we will forward the request directly to you for review, and for your specific consent.

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 the use or disclosure of your personal information. That decision may impair our ability to continue with timely, efficient treatment. If so, we will inform you.

Please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.

Do not hesitate to discuss our policies with any member of our staff.

For information, questions or concerns on our office’s privacy policies, contact:

Privacy Officer
Dr. Timothy R. Agapas
Dentistry Professional Corporation
5-2815 Princess Street
Kingston, Ontario
K7P 2X2

DR. TIMOTHY R. AGAPAS

Dentistry Professional Corporation

PRIVACY POLICY

​PATIENT CONSENT FOR COLLECTION, USE & DISCLOSURE OF PERSONAL INFORMATION

​

In this office, Dr. Timothy Agapas acts as the Privacy Information Officer.

All staff members who come in contact 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.

​

We will outline 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 information complies with existing legislation and privacy protocols

our privacy protocols comply with privacy legislation & standards of our regulatory body (the Royal College of Dental Surgeons of Ontario) and the law.

How our office collects, uses and discloses patients’ personal information

Our office understands the importance of protecting your personal information. We only collect what we absolutely need. To help you understand how we are doing that, we have outlined how our office is using and disclosing your information.

​

This office will collect, use & disclose 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 inform us of patients arrival and their location in the office with the check-in program

to enable pertinent patient information to be accessed at the dental chair

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 other dentists who are the referring dentists 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, lecturing, publishing and demonstrating purposes on an anonymous basis

to complete 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 the practice

to allow potential purchasers, practice brokers or advisors to conduct and 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

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

​

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 fulfilling its mandate under the RHPA, and for the defense of a legal issue.

​

Our office will not under any conditions supply your insurer with your confidential medical history. In the event this kind of a request is made, we will forward the request directly to you for review, and for your specific consent.

​

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 the use or disclosure of your personal information. That decision may impair our ability to continue with timely, efficient treatment. If so, we will inform you.

​

Please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.

​

Do not hesitate to discuss our policies with any member of our staff.

​

For information, questions or concerns on our office’s privacy policies, contact:

Privacy Officer Dr. Timothy R. Agapas Dentistry Professional Corporation 5-2815 Princess Street Kingston, Ontario K7P 2X2

PATIENT CONSENT FOR COLLECTION, USE & DISCLOSURE OF PERSONAL INFORMATION

Privacy Officer
Dr. Timothy R. Agapas
Dentistry Professional Corporation
5-2815 Princess Street
Kingston, Ontario
K7P 2X2