As the physician of your clinic, please read and sign below:

i) The College of Physician and Surgeons direct every clinic to follow the Privacy Information Protection Act. Programs like eFax (even conventional faxes) and email can and often breach PIPA.

ii) I am aware that due to the outbreak of COVID, Canada Post’s registered mail service at times does not require an ID check or signature. Patient’s medical records may be simply left outside my clinic, elevating the breach of privacy and risk for the patient.

iii) MedRecords provides a secure digital download solution to transfer records to clinics. They have offered this service free of charge to our clinic. I have declined to use this secure free of charge service.

iv) I request that MedRecords attempt to send me records through Canada Post and my clinic will accept the responsibilities regarding the release of information.

v) In the future, I request that all patients bring in their personal copy of their medical records. I am aware this will result in the patient paying an additional $65 for processing, and Canada Post’s shipping fee.

vi) I consent to the disclosure of this document to any medical governing body and Office of the Information and Privacy Commissioner (OPIC) upon inquiry and may also be submitted in advance.