Given that this group is a partnership between CMHA Thames Valley Addiction and Mental Health Services and Crouch Neighbourhood Resource Centre, there may be times where information about participant attendance, participation, etc. is shared between these community partners; by clicking the consent box below, you express agreement to the sharing of information where necessary and relevant between CMHA Thames Valley Addiction and Mental Health Services and Crouch Neighbourhood Resource Centre.
Consent * By clicking here, I agree to the Information Sharing and Consent Policy.
Information Sharing and Consent Policy
Collection of Personal Health Information:
We collect personal health information about you directly from you or from the person acting on your behalf.
What do we collect? For the purpose of virtual groups we will collect the following:
• Your name
• Date of birth
• Email address
• Group registrations
We may also collect:
Your preferred language eg. English, educational status, employment status Etc.
We use this and other information provided for program planning and evaluation purposes.
Information from other Health Sources:
We may also collect personal health information about you from other sources for the purposes of providing care if the law permits, unless you have explicitly withdrawn your consent for us to do so.
What do we do with the Information?
1. Provide you with mental health services and supports
2. Plan, administer and manage our internal operations
3. Conduct risk management activities
4. Conduct quality improvement activities (satisfaction surveys, accreditation)
5. Compile statistics, teach, participate in research
6. Fulfill other purposes permitted or required by law
Information collected will only be disclosed and used by persons working for, or on behalf of CMHA Middlesex e.g. students, volunteers, consultants, or researchers. High level statistical information that does not identify you is shared with our funders.
When information needs to be shared with others outside of CMHA Middlesex we obtain your express consent, except where there is a serious risk of harm to you or someone else, suspicion of child abuse, or as required by law e.g. court order.
You may access and request corrections to your personal health records, or withdraw your consent for some of the above uses and disclosures by contacting us (subject to legal exceptions).
In accordance with the guidelines set out by the Ministry of Health and Long-Term Care and the Personal Health Information Protection Act, 2004, we take steps to protect your personal health information from theft, loss and unauthorized access, copying, modification, use, disclosure and disposal.
For more information, email Privacy@cmhamiddlesex.ca
You have the right to complain to the Information Privacy Commissioner (IPC) /Ontario if you think we have violated your rights.
Information Privacy Commissioner
www.ipc.on.ca or call 1 800 387 0073
Risks of Using Videoconferencing Services:
CMHA Elgin Middlesex staff and the individuals engaging in this alternative service delivery method will use all reasonable measures to protect the security and confidentiality of the information sent and received using videoconferencing, however, please note:
• Use of electronic communication can increase the risk of said information being disclosed to third parties despite reasonable efforts to protect privacy security of electronic communication
• Electronic communication can be intercepted and therefore saved, stored, forwarded, and circulated and even changed without the knowledge or permission of either party
• It is possible that through electronic communication, malware may be introduced to the computer
• There is a risk that services could be disrupted or distorted by unforeseen technical problems. Please provide the CMHA Elgin Middlesex staff member providing the service with feedback, should you find the quality of video sessions insufficient for your needs.
• Using public wifi can increase security risks. Where possible a secure internet connection should be used to decrease the risk of a privacy breach.
• There is also a risk of being overheard by anyone near you if you do not place yourself in a private room. You, the participant, are responsible for creating a comfortable and safe environment on your end for the duration of the videoconferencing session. It is the responsibility of the CMHA Elgin Middlesex staff member providing the service to do the same on their end. They will complete all videoconferencing services in a secure and protected space.
Virtual Registration/Drop in Groups/Workshops Consent:
By providing the information below, I agree that I have read and understand the information provided regarding the drop-in group, collection, use, and disclosure of information. I hereby give my consent to CMHA Elgin Middlesex to provide drop-in/group services to myself, and to collect and use my information for the purposes stated above. I agree to meet online through video or teleconferencing using an alternate service provider (i.e. Zoom, Skype, etc.).