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Clinician Login

 Your Privacy and Personal Information

  KAYMAR REHABILITATION                  

PATIENT NAME: _________________________ CTN: ________________________________

304-1471 John Counter Boulevard   Kingston, Ontario. K7M 8S8  (613) 542-8739                                                                                              

Privacy Statement

Kaymar Rehabilitation Inc. (Kaymar) is a service provider agency of the South East Community Care Access Centre (CCAC). Your Care Coordinator at the CCAC requested Kaymar Rehabilitation to provide services for you in your home.

Kaymar Rehabilitation employs clinicians who provide nutrition counseling, occupational therapy, physiotherapy, speech and language services and social work intervention.

Kaymar Rehabilitation has policies and procedures in place to protect the privacy of the personal and health information collected by these clinicians. The policies outline how this personal and health information is to be collected, used, stored, disclosed, corrected and disposed of in accordance with the latest provincial governments' information legislations.

You may contact the Manger of Rehabilitation Services at Kaymar Rehabilitation if you wish to read these policies and procedures or your personal/health information record.                                                             

Permission To Collect Personal Health Information

The primary purpose for collecting personal health information about you is to be able to provide you with therapy, nutritional counseling and/or social work services.

We collect information about your health history, your physical condition and function and your social situation in order to help us assess what your needs are, to advise you of your options, and then, to provide the health care you choose to have. Kaymar Rehabilitation may need to share this health information with the South East Community Care Access Centre and its contracted service providers who supply nursing and personal support workers.  You have the right to withdraw your consent at any time; this must be presented in writing to Kaymar Rehabilitation. 

 Consent:

 I,                                                                                                , give permission to Kaymar Rehabilitation to collect, use and disclose the personal health information of ___________________, for the purposes stated above. I understand that Kaymar Rehabilitation has policies and procedures in place that follow the provincial rules to protect the privacy of this information.

I understand that I may withdraw my consent at any time by providing written notice to Kaymar Rehabilitation.  This withdrawal of consent will be in effect from the time and date of my signature onwards.

 Date: _______________________________    Signature: ____________________________

       Spouse         Family member      Parent    Guardian      Power of Attorney

  KAYMAR REHABILITATION                  

CLIENT NAME: _________________________ CTN: ________________________________

304-1471 John Counter Boulevard   Kingston, Ontario. K7M 8S8   (613) 542-8739                                                                                              

 

 Permission To Collect Personal Health Information

 Families/Caregivers:

The primary purpose for collecting personal health information is to allow input from the family and/or caregiver as a means of ensuring that we have a complete summary of the client's needs.

The information we collect will enable service providers to co-ordinate visits, to assess caregiver ability when teaching them treatment protocols and to establish an accurate picture of the client's needs. Service providers will educate family/caregivers to maximize client safety and independence as well as the client's ability to remain safely in the community.

Kaymar Rehabilitation may need to share this health information with the South East Community Care Access Centre and its contracted service providers who supply nursing and personal support workers.  You have the right to withdraw your consent at any time; this must be presented in writing to Kaymar Rehabilitation. 

 Consent:

 I,                                                                       , give permission to Kaymar Rehabilitation to collect, use and disclose the personal health information about myself for the purposes stated above.

I understand that Kaymar Rehabilitation has policies and procedures in place that follow the provincial rules to protect the privacy of this information.

I understand that I may withdraw my consent at any time by providing written notice to Kaymar Rehabilitation Inc.  This withdrawal of consent will be in effect from the time and date of my signature onwards.

Date: ____________________               Signature:_______________________________

 How to Reach Us

If you have any questions or concerns about our privacy practices, please call (613)542-8739 and ask to speak to the manager.
 

Information and Privacy Commissioner

The Information and Privacy Commissioner of Ontario is responsible for making sure that privacy law is followed in Ontario. For more information about your privacy rights, or if you are not able to resolve a problem directly with us and wish to make a complaint, please contact  the Information and Privacy Commissioner of Ontario
 

 

Our Purpose
Our 40-member team of dedicated, multi-disciplinary professionals strives to support adults, families and children as they respond to the challenges of living, working and learning in their communities.
Contact Us

304 1471 John Counter Boulevard, Kingston, Ontario. K7M 8S8

Tel: (613) 542-8739
Fax: (613) 542-8468