TH respects your right to access your personal health information within its’ custody and control. Personal health information is any verbal, written or electronic information about you, your health or health care history. This includes your name, date of birth, address, phone number and OHIP number. It also includes tests, treatment and care information or personal and family information that you or your family/substitute decision-maker has told your doctor or other people involved in your care.

You can ask to look at your record(s) or request copies of your personal health information. A fee may apply. You can make a request by completing the Request for Access to Personal Health Information form and mailing it, or dropping it off, with an original signature to:

Attn: Health Records Temiskaming Hospital 421 Shepherdson Road New Liskeard, ON P0J 1P0

Phone: 705.647.8121 Ext. 2135 (Health Records Clerk)

Fax: 705.547.4154

Request Form

Request for Access to Personal Health Information

• Patients or their eligible substitute decision makers/Power of Attorney and/or executor of estate are entitled to access their health information. Some requests may be subject to approval by the health care provider.

• All requests must be made in writing by completing the Consent for Release of Personal Health Information form, which can be accessed here.

• Records are processed according to medical priority sequencing and will be completed in a timely manner. In accordance with the “Personal Health Information Protection Act” PHIPA, we have up to 30 days to process a completed request, but we strive to complete your request as soon as possible. Please discuss timelines further with the Health Records Clerk.

• Health Records staff are unable to interpret or advise on health issues or on the care documented in the records. We recommend that health information be reviewed in conjunction with your health care provider, so that interpretation may be provided if necessary.

• E-mail is not considered a safe and secure means of communication. We do not use e-mail to respond to requests for health records.

• Completed requests can be mailed, faxed or hand-delivered to the Temiskaming Hospital to the attention of the Health Records Department.

Individuals can request a personal claims history from the Ministry of Health at no cost.

What is a Personal Claims History?

A personal claims history is a computer record of claims paid by OHIP. It lists payments made to health care professionals for medical services received by an individual under their Ontario health card. The report lists the following information:

• the date services were received

• the health care professional who performed the services

• where the services took place.

You can ask to have your personal health information corrected as appropriate. For example, we can correct your date of birth but we cannot correct an opinion or an observation made by a health care professional in good faith about a patient.

Request for Correction to Personal Health Information

We have electronic and paper records of your personal health information that are updated each time you visit Temiskaming Hospital. This information is used by our health professionals and students involved in your care. There are other health-care providers external to Temiskaming Hospital who can access your electronic health record if they or their team are involved in your care.

We assume you consent to share your health information with external health-care providers involved in your care, such as doctors, hospitals, clinics, long-term care homes, and community agencies. We may also ask external health-care providers for information about you, if we need it for your care.

TH may use your information to:

• Educate our students and staff

• Notify you of an appointment or change to an appointment

• Locate you or your family in urgent/emergent situations using an overhead paging system

• Conduct research

• Compile statistics

• Plan, administer and manage our internal operations

• Enhance safety and security

• Conduct risk management and quality improvement activities

• Conduct patient satisfaction surveys

• Fundraise (your name and address only)

• Get payment from OHIP, WSIB, private insurers or others

• Obtain required information for patients detained under the Mental Health Act or Criminal Code of Canada

• Refer you to an authorized community partner, such as the Red Cross, who may be able to assist you in accessing available community services

• External electronic health record systems such as: Client Information Management System (CIMS), Integrated Services for Children’s Information System (ISCIS), Integrated Assessment Record (IAR), and Electronic Children’s Health Network (eCHN), and to facilitate the provincial government’s goal of providing a commonly available electronic health record.

• Ministry of Health and Long Term Care e-health projects such as: the Enterprise Master Patient Index (EMPI), Wait Time Information System (WTIS), Drug Profile Viewer, Ontario Renal Reporting System (ORRS), and Ontario Laboratory Information System (OLIS)

• Approved provincial agencies such as: Cancer Care Ontario, the Institute for Clinical Evaluative Sciences, the Canadian Institute for Health Information, Ontario Institute for Cancer Research, BORN, and Trillium Gift of Life.

• Comply with legal and regulatory requirements

We may collect, use and disclose personal health information on a need to know basis with the “Circle of Care”, which includes:

• Our staff who need to know to provide care, including: physicians, nurses, technicians, therapists and other health care professionals • Other health care providers who are not our employees but may be required to assist in providing health care for you, including: • Health care practitioners and groups of health care practitioners, • Hospitals – public, psychiatric and private • Pharmacies • Laboratories • Ambulance Services • Nursing Homes • Retirement Homes • Other care homes • Homes for Special Care • Community health or mental health centres • Community Care Access Centres (CCAC) • Community Service Providers • Independent health facilities • Programs and services whose primary purposes are providing health care

TH may disclose your information to:

• Facilitate the federal and provincial governments’ goal of providing Canadians with an electronic health record. Your TH information will be stored securely on shared health information databases, accessible by your authorized health care provider(s) within the region, province or nation. • Our hospital foundation(s), so they may conduct fundraising to improve our health care facilities, services and programs. • Our patient directory: Your name, location and general health status may be given out to persons who are asking for you by phone or in person.

A freedom of information request is a request completed by a member of the public for access or a correction to records. A freedom of information request does not apply to Personal Health Information. If your request is for health records, please view our Privacy and Confidentiality page.

You can request access to general medical records or your personal information or request a correction to your personal information using the Request Form for Correction to Personal Health Information (insert hyperlink). Once you have completed and signed the form, send it or hand‐deliver it to:

Privacy Office-Temiskaming Hospital

Attn: Privacy Officer

421 Shepherdson Drive, New Liskeard, P0J1P0

Please include a cheque or money order for the required fee of $5.00. Do not mail cash. All fees are payable to Temiskaming Hospital.

If your request is for health records, please view the Privacy & Confidentiality page.

This form is not for requests of personal health information.

FIPPA Fee Schedule (see table 1 HER-6 Policy)

Additional information regarding fees:

• Payment of fees is required prior to the release of documentation.

• Every effort will be made to provide a fee estimate when the fees of processing your access request are expected to exceed $30.00.

• If estimated fees are greater than $100, a deposit of 50% of the total estimated fee may be required before any further steps are taken to respond to the request.

• Appeal fees of $10.00 for personal information requests and $25.00 for general information requests are payable to the Office of the Information & Privacy Commissioner.

How your request will be processed

1. The Privacy Office will log your request and review it to ensure it is complete and If there are any questions, the Privacy Office will contact you to discuss.

2. The Privacy Office will contact the Health Records department at TH asking them to locate the records and forward to the Privacy Officer.

3. The Privacy Office will consider exemptions and exclusions and prepare a letter to advise you which of the requested records you are permitted to

4. If access is granted in full, you will receive a copy of the record.

5. If access is granted in part, this means access to some records has been redacted. You will receive a copy of the records, however, information will appear blacked out on your copy. The letter will state the reason why access to specific information was redacted.

6. In some cases information will be denied in full. If this is the case, the letter of response will explain what exclusion or exemption was applied to arrive at this decision. You will also be advised how to appeal TH’s decision.

7. TH must respond to your request within 30 days of receiving your formal request. If your request is for a large number of records, requires extensive search, or consultation with an external third party, the time limit may be extended. You will be advised of any time extensions.

How to Appeal the results of an FOI request

TH may decide not to release all of the information that you request. In our decision letter, we will cite the sections of FIPPA we are using to withhold the information from you.

If you disagree, you can then ask the Office of the Information and Privacy Commissioner (IPC) of Ontario to review the decision by making an “appeal”.

You can do this by writing a letter describing why you are not satisfied with TH’s decision. Alternatively, you may use IPC’s Appeal Form which can be found online at the Information and Privacy Commissioner of Ontario.

Please enclose an appeal fee of $10.00 (for personal information) or $25.00 (for general information) and send your appeal to:

Registrar

Information and Privacy Commissioner/Ontario 1400‐2 Bloor Street East Toronto, ON M4W 1A8 Tel: 416-326-3333 Toll‐free Ontario: 1-800-387-0073