Students’ Union Wellness Centre Patient Records | Archives and Special Collections

Students’ Union Wellness Centre Patient Records – Archives and Special Collections

Students’ Union Wellness Centre Patient Records

UCLASS Primary: ST675 – Student Health & Wellness

Retention Rule Number: Specific Retention Rule 2013.04

Function/Activity: To document patient history, examinations and treatment of individuals accessing Health Services (medical, massage, chiropractic, nutrition) through the Students’ Union Wellness Centre

Description/Type of Records: Patient’s demographic information; physician’s notes and patient histories; test results and results of physical examinations; diagnosis and treatment notes; instructions and advice; referral letters.

Retention Rules

Office of Primary Responsibility (OPR) Retention Disposition
Students’ Union Wellness Centre – Health Services
Patient records — except those involving a “person under disability”* or allegations of sexual assault, battery or misconduct: Date of last visit + 12 years, or in the case of minors, for 12 years past the client’s age of majority Confidential shred or delete
Patient records involving allegations of sexual assault, battery or misconduct: Date of last visit + 70 years Confidential shred or delete
Patient records involving “persons under disability”*: Date of last visit + 70 years Confidential shred or delete

* “Person under disability” is defined in the Limitations Act, s.1(h) as “(i) a represented adult as defined in the Adult Guardianship Act or a person in respect of whom a certificate of incapacity is in effect under the Public Trustee Act, or (ii) an adult who is unable to make reasonable judgements in respect of matters relating to a claim.”

Restrictions:
Access to these records is restricted due to personal information contained therein to the patient and to staff assigned the authority to compile, classify, annotate, read, retrieve, transfer or destroy this record series.  If access to their record is denied the patient under Section 11 of theHealth Information Act, application for access can be made through a Health Information Act request.

Records Management Instructions:
For ease of administering the disposition of these records:
  1. Files will be maintained according to the series outlined.
  2. Files of minor patients will be filed at the end of each series with the date of birth clearly noted.
Citations:
For Offices of Primary Responsibility (OPR):
College of Physicians and Surgeons of Alberta, Patient Records Standard, 21.
Massage Therapist Association of Alberta, Standards of Practice,13.
Alberta College and Association of Chiropractors, Standards of Practice, 5.4.
Professional Practice Handbook of Dietitians of Alberta, p. 155 – Record Retention and Disposal.
Limitations Act, Chapter L-15.1, s.1(f); s.3(1) and Chapter L-12, s.5.1(2).2018 Amendment:
Limitations Act, RSA 2000, Chapter L-12, s.3(1), s.3.1(1), 5(1), and s.5.1(2).

Approval Information:

  • Dr. J. Hong, Medical Director and Senior Physician, Students’ Union Wellness Centre
  • Debbie Bruckner, Students’ Union Wellness Centre Director
  • Jo-Ann Munn Gafuik, Senior Specialist, Policy & FOIP
  • Bonnie Woelk, University Records Committee (Chair)

7 November 2013

  • Karen Jackson, General Counsel
  • Dru Marshall, Vice President (Academic)
  • Bonnie Woelk, University Archives

Amended 22 June 2018