Protection of Information
Dr. Paul Rafie, chiropractor, is the person responsible for confidentiality and data protection on this site, in accordance with Law 25.
You can see below our consent form for the collection/use/protection of your information used at the clinic.
Chiroexcellence
CONSENT TO THE COLLECTION AND USE OF YOUR PERSONAL INFORMATION
This consent form is intended to inform you about how our clinic uses your personal information in maintaining your file, the risks inherent in this use, and to obtain your free and informed consent in relation to this use.
If you have any questions or comments regarding this consent, please contact:
Dr. Paul Rafie, Chiropractor
1600 Boul Henri-Bourassa O #202
Montreal, QC H3M 3E2, Canada.
Our person responsible for the protection of personal information.
In order to ensure proper traceability and timely access to your personal information only by those who require such access, we use information and communication technologies (hereinafter ICT) in compliance with the laws and regulations currently in effect in Quebec.
Collection and Use of Your Personal Information
At our clinic, your personal information is collected and recorded in paper files.
Persons Having Access to Your Personal Information
Only the following people, bound by a confidentiality agreement concerning patient personal information, may have access to your information (contact details/identification record):
a. Clinic staff who require it in the course of their employment;
b. The legal guardian of a patient under 14 years old;
c. Police or other competent authorities, if required by law.
The data entered in the care/treatment section of the file is strictly consulted by your chiropractor, who accesses it with their own personal password. Sharing of this section may only be done at your request and with your consent, with the persons specifically identified in this signed and dated authorization, which may also be revoked at any time upon your request.
In addition to the above persons, an entity involved in research, studies, statistical production, or a commercial transaction of the clinic may access certain depersonalized and anonymized data that does not allow you to be identified, in order to carry out their work.
Finally, you may at any time request access to the information collected by our clinic about you.
Right to Correct Your Personal Information
You have the right to access your personal information and request corrections if you consider it inaccurate, incomplete, or ambiguous, or if its collection or retention is not authorized by law.
It should be noted that the chiropractor may refuse such corrections if they conflict with applicable laws and regulations. In that case, you will be provided with a full justification for the refusal.
Protection of Your Personal Information
Access to your information is protected by a unique identifier and password for each member of our staff. We are therefore able to obtain a complete list of accesses, consultations, modifications, and sharing of your information, which allows us to monitor and detect problems or unauthorized access to your information.
Retention Period of Your Personal Information
Your personal information will be kept for a period of seven years following the last service provided by our clinic, as required by your chiropractor’s professional obligations.
Right to Withdraw Your Consent
You may withdraw your consent to the collection and use of your information at any time.
Notwithstanding the above, our clinic may be required to retain your information for the period prescribed by the professional obligations of the chiropractors working here.
My Consent
I declare that I have read and understood all the provisions relating to the collection and use of my personal information through information technologies (ICT). I freely and knowingly consent to the collection and use of my personal information through ICT in accordance with the terms of this consent.
Patient’s Name (printed) __________________________________
Patient’s Date of Birth __________________________________
Patient’s Signature __________________________________
Responsible Person’s Name (printed) __________________________________
Responsible Person’s Signature _____________________________
Date ___________________