Privacy of your personal information is an important part for our office and we understand the importance of protecting such information. We are committed to collecting, using and disclosing your personal information responsibly. In this office, Dr. Wiliam Rodriguez is the Privacy Information. All Staff members who come in contact with your personal information is 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 the information. Our office ensures that: (1) only necessary information is collected about you; (2) we only share your information with your consent; (3)storage, retention and destruction of your personal information complies with existing legislation and privacy protection protocols; (4) our privacy protocols compile with privacy legislation, standards of our regulatory body, the Royal College of Dental surgeons of Ontario, and the law.

This office will collect use and disclose information about you for the following purposes:

(1) to deliver safe and efficient patient care; (2) to identify and to ensure continuous high quality service; (3) to assess your needs; (4) to provide healthcare; (5) to advise you of treatment options; (6) to enable us to contact you; (7) to establish and maintain communication with you; (8) to offer and provide treatment, care and services in relation to the oral and maxillofacial complex and dental care generally; (9) to communicate with other treating health care providers, including specialists and general dentists who are the referring dentists and/or peripheral dentists (10) to allow as to maintain communication and contact with you to distribute health care information and to book and confirm appointments; (11) to allow us to efficiently follow-up for treatment care and building; (12) for teaching and demonstrating purposes on an anonymous basis; (13) to complete and submit dental clains for third party adjudication and payment; (14) to compile with legal and regulatory requirements including the delivery of patience 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 Professionals Act (15) to compile with agreements/undertakings entered into volunteerly by an by any of our dentist with the Royal College of Dental Surgeons of Ontario, including the delivery and/or review of patience charts and records to the college in a timely fashion for regulatory and monitoring purposes; (16) to permit potential purchasers, practice brokers or advisors to evaluate the dental practice; (17) to allow potential purchases practice brokers or advert advicers to conduct an audit in preparation for a practice sale; (18) to deliver your chats and records to the dentist's insurance carrier to enable this insurance company to assess liability and quantify damages, if any; (19) to prepare materials for the Health Professions Appeal and Review Board (HPARB); (20) to invoice for goods and services; (21) to process credit card payments; (22) to collect unpaid accounts; (23) to assist this office to comply with all regulatory requirements; and (24) to comply generally with the law.

By signing the consent section of this Patient Consent Form, you have agreed that you have given your informed consent to the collecton,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 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.