Case History Form   New to ReNu?

Please complete the Case History Form before your first visit.
     
     
 

 
     
     
     
  Your privacy is protected with usÖ

ReNu Health and Wellness must collect personal information from you in order to safely treat you. It is extremely important that this information be collected responsibly and that it only be disclosed to other individuals under appropriate circumstances. This document details your rights and how your information is protected.

What is personal information?
Personal information is information about identifiable individuals. Personal information includes information that relates to:

  • an individualís personal characteristics (e.g., gender, age, income, home address or telephone number, ethnic background, family status);
  • health (e.g., health history, health conditions, health services received by them);
  • activities and views (e.g., opinions expressed by an individual, an opinion or evaluation of an individual).

Personal information is different from business information (e.g., an individualís business address and telephone number). This is not protected by privacy legislation.

Who can see your health information? 
When you request an appointment at ReNu Health and Wellness, we assume that we have your permission to collect, use and share that information with your other health care providers in our facility. This is limited only to those providers who you have actually seen for health care; other providers are not entitled to your information, except in the cases I have listed below.

If you do not want your therapist to use, share or give out some or all of your personal health information to other people who provide you with health care, please inform us as soon as possible. Please remember that some information is critical knowledge to know about an individual before treating them. If you present us with something confidential that you do not wish to be shared to another practitioner in the facility that may treat you. We might give you a detailed explanation as to why it is important for another health care provider to be aware of certain information.   

Other agencies or companies may need to see part of your health care information, such as your employer, insurance company or doctor. However, Massage Therapists cannot share information with these companies without your written permission.

You may also have family or friends to whom you would like us to give more detailed information about your health, like how your treatment is working or what kind of care you will need at home. You can let us know if we can discuss your health with family and friends. We must have your consent in order to do so.

When Your Consent is Not Required
Massage Therapists are allowed or may be required to use and/or give out some of your personal health information without consent in the following situations:

  • To report certain information, such as to report certain diseases to public health authorities.
  • When we suspect certain types of abuse.
  • To reduce a significant risk of serious bodily harm to a person or the public
  • For risk management and legal purposes.
  • To transfer or sell the professional practice to another person and to allow that person to assess the practice, so long as he or she signs an agreement to keep the information confidential and secure.
  • To assess a persons ability to make health care and other important decisions.
  • For administration or enforcement of laws about the practices of health care providers, such as when our regulatory body (the CMTO) does a peer assessment in our facility.
  • For the purpose of a legal proceeding or complying with a court order, or other legal requirements.

Marketing and Personal Information
Your personal information will never be provided to anyone for marketing purposes.

Security
We understand the importance of protecting your personal information. For that reason, we have taken the following steps:

  • Paper information is either under supervision or secured in a locked filing cabinet.
  • Computers and backups are under supervision or secure in a locked or restricted area at all times. In addition, passwords are used on computers, and screens are locked when they are not in use.
  • Files that are inactive for more than a year are stored off site locked and protected. 

Retention of Personal Information
We are required to retain personal information for ten years to ensure that we can answer any question you may have about the services provided and for our own accountability to the College of Massage Therapists (CMTO).

We destroy paper files containing personal information by shredding. We destroy electronic information by deleting it and, when the hardware is discarded, physically destroying the hard drive.

Viewing your own personal information
With only a few exceptions, you have the right to see what personal information we hold about you. We will try to help you understand any information that may be unclear (e.g., short forms, technical language, etc.). If you would like a copy of your personal information, please make your request in writing. We reserve the right to charge a fee for such requests.

Some exceptions may apply. For example, when the information relates to law enforcement, legal proceedings or another individual, you may not get to see the record.

We must respond to your request as soon as possible and within 30 days. There may be a delay if we have to ask others about your records or if it will take time to find the record. You have the right to be notified of such delays. If you require the record urgently, please let us know and we will do our best to get it to you.

If you believe there is a mistake in your information, you have the right to ask for it to be corrected. You must make this request in writing, stating specifically what in your record is incorrect or incomplete.

Do note that we cannot correct a record that was created by someone else as we do not know enough about the record to change it. Also, we cannot correct details where, for example, the opinions or observations in the record were made in good faith. You are entitled to be told the reasons for not making a correction and of your right to have a statement of disagreement attached to your records. You can also ask to have this statement made available to those who see the record.

If we correct a record, it must be done carefully so that the full corrected record remains visible or by ensuring that the corrected version is readily available.

Questions
If you would like further information, you can contact ReNu Health and Wellness at 519-662-6277 and we can discuss any questions or concerns you may have.  As well, if you have a formal complaint to make concerning ReNu Health and Wellness privacy practices, you should contact us in writing. 

The address of the clinic is:

ReNu Health and Wellness
251 C Huron St, New Hamburg, Ontario, N3A 2Z7

We will respond to your concerns promptly.  If after discussing the issue with us and if we are still not able to resolve your complaint or concern, you have the right to make a formal complaint to the Privacy Commissioner of Ontario. This must be done within one year of the matter you are complaining about. Their office can be reached at:

Information and Privacy Commissioner/Ontario
2 Bloor Street East, Suite 1400
Toronto, Ontario M4W 1A8
Telephone: 416 326 3333
or 1 800 387 0073
Facsimile: 416 325 9195
TTY: 416 325 7539
Website: www.ipc.on.ca
Email address: info@ipc.on.ca

 

 

 

 

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