PRIVACY STATEMENT

I am committed to respecting and protecting your privacy. This statement outlines my policies and procedures with respect to collecting, using and disclosing your personal health information.

Privacy of personal information is an important part of providing you with quality Psychological Services. I am committed to collecting, using and disclosing personal information responsibly and only to the extent necessary for the services I provide. I collect personal health information only directly from you, except: a) when you have provided consent to obtain such information from others (e.g., reports of previous assessments); and b) where the law requires or allows us to collect information without your consent (e.g., in an urgent situation, where information is needed to prevent potential harm).

I collect only that information from you that I believe is reasonably necessary to provide you with services. If I collect information from you for any other purpose (e.g., research), it will be done only with your knowledge and consent. If you decide that you do not want to provide this information not needed for your service, you are completely free to refuse. These will be no impact on your services.

By law and in accordance with professional standards, I am required to keep a record of our services to and contacts with you. Your record includes information you provide to us or authorize us to receive, results of any assessments, your service plan, consent forms, contact notes, billing information, and correspondence that I have sent or received related to your service. The physical records are the property of my practice. However, you have rights regarding access to your record and regarding disclosure of information from your record (see below), regardless of the form in which the information is recorded. In this office, information is recorded in both written and electronic form.

Your personal health information is used to provide you with service. This includes using the information for service planning, monitoring and billing purposes. In addition, I also use some information for quality improvement and trainee education. Further, being a member of the College of Psychologists of Ontario, your record may be occasionally accessed for external auditing purposes.

The people that come into contact with your personal information are aware of the sensitive nature of the information that you have disclosed. They have been trained in the appropriate uses and protection of your personal information according to the guidelines stipulated by the Personal Health Information Protection Act (PHIPA).

With only a few exceptions, your personal health information will not be disclosed to persons outside this practice without your knowledge and express consent. The exceptions are: a) some circumstances in which disclosure is allowed by law (e.g., when there is a clear and imminent risk of serious bodily harm to someone, including the possibility of self-harm; when disclosure is needed to receive professional or legal consultation); and b) when disclosure is required by law (e.g., mandatory reporting of a child who might be in need of protection; mandatory reporting of a regulated health professional who has sexually abused a client; a court order to release information from a record).

The above exceptions are called "limits of confidentiality." If there are other limits of confidentiality in your situation, I will identify and discuss them with you before proceeding with your service.

Please note that the law requires any disclosure of your personal health information to be limited to information that is reasonably necessary for the purpose of the disclosure, and not to include private information provided by a third party. Professional ethical standards additionally require that any information that might cause serious harm to someone not be disclosed, unless the law requires disclosure.

I need to retain personal information for some time to ensure that I can answer any questions you might have about the services provided and for our own accountability to external regulatory bodies. As stipulated by the College of Psychologists, client files are to be kept for 10 years past the last contact for adult clients. For child and adolescent clients records are kept for 10 years past the date at which they would turn 18 years of age. I will remove contact information on our data base when it appears that I will not be contacting you again or when you advise us that you wish no further contact from me.

I destroy paper files containing personal information by shredding. I destroy electronic information by deleting it, and when the hardware is discarded, I ensure that the hard drive is physically destroyed.

With only a few exceptions, you have the right to access any record of your personal health information, and to request copies of the information.

If you are the custodial parent or guardian of a child receiving service, you may not access (without the child’s consent) the personal health information of a child who was deemed competent and who consented to the service on his/her own. In addition, there are restrictions on custodial parents/guardians access to individual therapy notes regarding their children. (If this is your situation, I will provide you with further information).

If you believe that information in your record is not accurate, you may make a written request to correct your record. If I do not agree with the correction you request, you may file a notice of disagreement into your record.

I, Dr. Moustacalis, will speak to you directly to answer any questions you might have regarding this Privacy Statement. If you would like more detailed information at any time, would like to access or ask for a correction of your record, have a concern about my privacy policies and procedures, or have a complaint about the way your privacy has been handled, please do not hesitate to speak or write to me.

Complaints also may be addressed to:

The Information and Privacy Commissioner of Ontario

2 Bloor Street East, Suite 1400

Toronto, Ontario

M4W 1A8

416-326-3333 or 1-800-387-0073

Fax: 416-325-9195

TTY: 416-325-7539

Estes Moustacalis, Ph.D., C.Psych.  (Dr. “M”)

www.oakvillepsychologist.com

info@oakvillepsychologist.com

905 617-8308

Providing psychoeducational assessments and consultation on behalf of children with learning difficulties.