Notice of Purposes 

Personal information, health information and financial/employment information are collected to provide dietitian services and to facilitate the payment for provided services. Only the information necessary to provide services will be collected, and all information that is collected is protected and confidential. The information collected varies and includes but is not limited to:

Personal Information: name, home address, phone number, email address, and emergency contact information.

Health Information: the reason for referral or appointment, comprehensive health/food history (including relevant medical diagnoses (e.g. diabetes), lab work, diagnostic imaging results), nutrition-specific history (including family dynamics and roles, cooking and grocery shopping habits, relationship with food, history of dieting, disordered eating patterns or diagnosed eating disorders, history of food insecurity, substance use (alcohol and drugs), allergies, subjective health concerns, etc.), nutrition assessment, nutrition diagnosis, nutrition interventions, and evaluations.

Financial/Employment Information: employment status, insured health benefits (if any), financial status (to better determine purchasing power for food and health spending) and credit card information.

You do not have to provide information that you feel is not relevant to your care. 

Privacy Statement 

Privacy is of the utmost importance to any custodian of health information and every effort is made to comply with the privacy guidelines set forth by the Health Information Act. 

• Personal information, health, and financial information is stored electronically on practice management software that is PIPPA compliant. 

• Additional electronic safeguards include anti-virus protection, password-protected software, password-protected computers and devices, and confidential emailing. 

• Password-protected and confidential voicemail. 

• Any written documentation will be kept in a locked filing cabinet, in a private home office. Written documentation will be shredded when appropriate. 

• All staff or contractors are trained to act professionally and confidentially and are informed of all privacy policies. Any privacy concerns will be dealt with immediately and appropriate action will be taken to remedy the issue. 

• Staff will operate on a need-to-know basis, and only collect information that is relevant to their role in your care. 

• Privacy practices are reviewed annually and compared to the standards set forth by the College of Dietitians of Alberta and the Health Information Act, FOIP, and PIPPA  

Sharing of Your Information  

Collaborative care improves client outcomes, your information may be shared with relevant or referring healthcare providers if it is beneficial to your care. By signing your consent form, you agree to the sharing of your information with specific parties. The information shared will remain confidential, only relevant information will be shared and the specific parties will similarly protect your information.

Personal or health information may be shared with insurance companies for payment.

Personal health information can be shared without your consent under extenuating circumstances, including but not limited to disclosure to preserve the health or safety of any person, legal obligations, court obligations, external research, or to prevent abuse or fraud. 

Retention and Destruction Schedule  

Your personal, health, and financial information will be kept on file for 10 years. Records for minors will be kept for 2 years after the minor turns 18. During this time, you have the right to request to view your information or make an addendum to any information that you see fit. After a request to review your information, you will receive a response within 30 days. If there is reason to believe access to this information will cause harm to you or someone else, access will be refused. After 10 years, the information will be securely destroyed. A record will remain of the client’s name, date of last treatment, and the date the file was destroyed.