Embrace Dental Hygiene is a non-assignment office we make every effort for the treatment we provide to be client centered. Your dental insurance policy is a contract between you, your employer and your insurance company and due to Canadian and Ontario Governments Privacy Act your responsibility.
Whenever possible, we will electronically send your insurance claims which will speed the process for you and you should receive your insurance reimbursement within a few short days.
Payment is due for treatment on the day of the service. We accept all forms of payment.
Please provide us with 48 hours notice in the event that you need to cancel your appointment to avoid any cancellation fees.
Privacy of your personal information is an important part of our office providing you with quality dental hygiene 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 clients. In this office, Jennifer Mayhew 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. Attached to this consent form, we have outlined 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 personal information complies with existing legislation, and privacy protection protocols
- Our privacy protocols comply with privacy legislation, standards of our regulatory body, the College of Dental Hygienists of Ontario, and the law.
Do not hesitate to discuss our policies with me or any member of our office staff. Please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental hygiene care.
How Our Office Collects, Uses and Discloses Patients’ Personal Information
Our office understands the importance of protecting your personal information. To help you understand how we are doing that, we have outlined here how our office is using and disclosing your information. This office will collect, use and disclose information about you for the following purposes:
- To deliver safe efficient and individualized client care
- To identify and to ensure continuous high quality service
- To assess your health needs
- To provide health care and to advise you of treatment options
- To enable us to contact you to communicate with other treating health‐care providers, including specialists and general dentists
- To allow us to maintain communication and contact with you to distribute health‐care information and to reserve and confirm appointments
- To allow us to efficiently follow‐up for treatment, care and billing
- To complete and submit dental claims for third party adjudication and payment
- To comply with agreements/undertakings entered into voluntarily by the member with the College of Dental Hygienists of Ontario, including the delivery and/or review of clients’ 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 deliver your charts and records to the hygienist’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 (HPARB)
- 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 and to comply generally with the law
- By signing the consent section of this Client Consent Form, you have agreed that you have given your 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 College of Dental Hygienists of Ontario fulfilling its mandate under the RHPA, and for the defence 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 information 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 use or disclosure of your personal information, and we will explain the ramifications of that decision, and the process.
Personal Data Protection
Dental records are collections of sensitive personal client information compiled to allow dental hygienists and other dental health care providers to provide dental treatment, provide continuity of care and maintain optimal standards of care. Original dental records compiled by a dental hygienist are the legal property of the dental hygienist.
Clients have a legal right to examine and copy their records and to control the use and dissemination of the information contained in their records. Dental hygienists require clients to provide complete, accurate and intimate health details in order to provide safe and effective treatment. Therefore, ownership of original dental records obligate the security and confidentiality of this information contained therein which may be developed only with the permission of the client except when otherwise required by law.
Clients have the right to control disclosure of their dental records to others. Release of information must be informed; must be specific and for a one‐time event; must afford the client an opportunity to review that information requested and being released prior to the transfer and with an opportunity to withdraw prior consent; must not be used for any purpose other than the primary and specific use requested; and must be with the client’s permission, preferably in writing.
Clients are entitled to receive dental hygiene care in a confidential setting free of third party intrusion. Release of client information to third parties must adhere to the basic principles of confidentiality and client rights outlined above with the intention of enabling clients to review any and all third party benefits to which they may be entitled. Clients may be unaware of the information third parties may have access to under broad based consents to release dental records and the scope of this information may exceed the needs of third party to determine benefits. It becomes the responsibility of the dental hygienist and other dental health care providers to protect the confidentiality and privacy of their clients.
Where a third party (e.g. government agency, Canada Revenue Agency, dental association or insurance company) has received client permission to use information from the clients dental records for financial audits, all client identity and unrelated information (e.g. health history, personal information) shall first be removed from the records. No third party can demand access to client dental records (including financial records) except with specific client consent in writing, by legal statute or by court order.