Location

1219 Pembroke St. East, Pembroke, ON K8A 7R8.

HOURS

Monday – Friday 8:30 AM – 6 PM - some Saturdays and evenings available.
Hours may vary depending on clinician availability

Email

General Inquiries/Intake: admin@pembrokepsychology.com

CALL

Administration: 613-735-9582

FAX

General Fax: 343- 888-2009

Privacy and Personal Health Information Statement

Pembroke Psychological Services
Last updated: September 2026

Pembroke Psychological Services is committed to protecting the privacy, confidentiality, and security of personal health information. This statement explains how personal health information is collected, used, disclosed, stored, accessed, corrected and protected when individuals receive services from clinicians practising at Pembroke Psychological Services.

Our privacy practices are governed by Ontario's Personal Health Information Protection Act, 2004 (PHIPA) and the professional and regulatory requirements applicable to each clinician.

Our Practice Structure and Responsibility for Your Record

Pembroke Psychological Services is a collaborative practice. Clinicians work alongside one another and may share administrative resources, but each independently practising clinician remains responsible for their own clients and clinical records.

In most circumstances, your treating clinician is the Health Information Custodian responsible for your personal health information.

Working within Pembroke Psychological Services does not give other clinicians automatic access to your clinical record.

Where services are provided by a student, psychometrist, clinician in supervised practice, or another provider working under clinical supervision, the supervising clinician has access to information necessary to provide supervision and fulfil their professional responsibilities.

Clients receiving supervised services will be informed of:

• the name and credentials of the person providing the service;

• the identity and contact information of the supervisor;

• the nature of the supervisory relationship; and

• who is the Health Information Custodian responsible for the record.

If you are uncertain who is responsible for your record, please ask your clinician or contact the Pembroke Psychological Services Privacy Lead.

Information We Collect

Depending on the services you receive, personal health information may include:

• name, date of birth and contact information;

• emergency contact information;

• referral information and referral questions;

• health, developmental, family, social, educational and vocational history;

• information discussed during assessment or treatment;

• clinical notes, treatment plans and correspondence;

• psychological or psychometric assessment information;

• consent forms;

• appointment and attendance information;

• insurance, funding and billing information; and

• other information reasonably necessary to provide or administer services.

We seek to collect only the information reasonably necessary for the purpose for which it is required.

Intake, Referrals and Waitlists

Information may be collected directly from you or, with appropriate authority, from a referring health professional, insurer, agency, school, employer, government program, legal representative or other referral source.

During intake, limited information may be reviewed by authorized administrative staff or clinicians for purposes such as:

• understanding the reason for referral;

• determining the appropriate service or clinician;

• managing urgency or clinical suitability;

• coordinating funding or authorization; and

• arranging an appointment.

If you are placed on a waitlist, Pembroke Psychological Services may maintain limited information necessary to manage the referral, including your contact information, requested service, relevant referral questions and clinician requirements.

Referral and waitlist information is accessible only to individuals who require it for authorized intake, referral or administrative purposes. Placement on a Pembroke Psychological Services waitlist does not give all clinicians access to your information.

Electronic Records and OWL Practice

Pembroke Psychological Services uses OWL Practice for electronic health records and practice-management functions. Depending on the service, OWL Practice may be used for:

• intake and consent forms;

• scheduling;

• clinical documentation;

• secure messaging;

• virtual appointments;

• assessment records;

• billing; and

• document storage.

Use of a common electronic platform does not mean that every clinician can access every client's record.

Access is limited according to clinical responsibility, supervisory responsibility, administrative role and legitimate need.

Clinicians remain responsible for ensuring that electronic records under their custody or control are handled in accordance with PHIPA and their professional obligations, including appropriate safeguards for access, transmission, storage and secure destruction.

Email, Telephone and Voicemail

Email and telephone may be used for intake, scheduling, referral coordination and other appropriate communication.

Ordinary email is not completely secure. Sensitive personal health information should therefore be limited when communicating through regular email, and a more secure method may be recommended for sensitive documents or clinical information.

Clients may advise their clinician or administrative staff about preferences or restrictions regarding telephone messages, voicemail or email communication.

Paper Records and Documents

Paper documents may include referral letters, questionnaires, consent forms, correspondence, assessment materials or other records.

Paper documents containing personal health information are stored, transported and destroyed using reasonable safeguards appropriate to their sensitivity.

Assessments and Psychological Testing

Assessment records may include interview information, questionnaires, observations, collateral information, test scores, assessment data, reports and recommendations.

Psychological test materials and raw test data may be subject to additional professional, legal, copyright and test-security requirements. These requirements may affect how certain assessment materials are stored, disclosed or provided in response to an access request.

When assessment services are performed by a psychometrist, student or other provider under supervision, the supervising clinician may review and access information necessary to oversee and take responsibility for the assessment.

Supervision, Students and Trainees

Clients will be informed when their services involve clinical supervision or the participation of a student or trainee.

Information reasonably necessary for supervision may be reviewed with the supervising clinician. This may include clinical records, assessment findings, treatment planning, risk concerns and clinical decision-making.

Students, trainees and supervised providers are required to maintain confidentiality and may access information only as necessary for their role and supervision.

Supervision does not provide unrelated clinicians at Pembroke Psychological Services with access to a client's record.

Professional Consultation

A clinician may consult with another health professional when consultation is appropriate to support client care.

Whenever reasonably possible, consultation will use de-identified information. Where identifiable personal health information must be shared, the clinician will obtain consent when required or rely on another lawful authority under PHIPA.

Working collaboratively at Pembroke Psychological Services does not permit unrestricted sharing of identifiable client information.

Administrative Staff and Other Agents

Administrative staff may access limited personal health information where necessary to perform authorized functions such as:

• intake;

• scheduling;

• referral and waitlist coordination;

• billing and payment processing;

• document management; and

• communication with clients.

Administrative access is based on role and need. Administrative personnel do not have unrestricted access to clinical information simply because they work at Pembroke Psychological Services.

Clinicians may also use service providers for electronic records, information technology, accounting, payment processing or secure communication. Where these providers handle personal health information on behalf of a Health Information Custodian, appropriate privacy and confidentiality safeguards are required.

Billing, Insurers and Third-Party Funders

Information may be collected, used or disclosed as necessary to prepare invoices, process payment, confirm authorization or administer insurance and third-party funding.

This may involve insurers or programs such as Veterans Affairs Canada, WSIB, automobile insurers, employee benefit plans or other third-party funders.

Only information reasonably necessary for billing, authorization or payment will be disclosed unless you provide consent for additional information or disclosure is otherwise permitted or required by law.

Payment for services by an insurer, employer, family member or other third party does not automatically provide that payer with access to your clinical record.

For third-party assessments, the clinician will explain the purpose of the assessment, intended recipient of the report, information that may be disclosed and relevant limits of confidentiality as part of the consent process.

How Your Information May Be Used

Personal health information may be used as reasonably necessary to:

• provide assessment, treatment or consultation;

• develop and review treatment plans;

• provide clinical supervision;

• coordinate referrals and services;

• manage appointments and waitlists;

• communicate with you;

• maintain clinical records;

• address clinical risk or safety concerns;

• process billing and funding;

• meet professional and regulatory requirements; and

• comply with legal obligations.

Information will not be used for an unrelated purpose without consent unless the use is otherwise permitted or required by law.

Disclosure of Personal Health Information

Personal health information is generally disclosed with consent.

There are circumstances in which disclosure may be permitted or required without consent, including certain situations involving risk of serious harm, mandatory reporting obligations, legal proceedings, court orders, regulatory requirements or other circumstances authorized by law.

When information is disclosed, only information reasonably necessary for the lawful purpose will be provided.

Protecting Your Information

Reasonable administrative, physical and technical safeguards are used to protect personal health information from loss, theft, unauthorized access, use, disclosure, copying, modification or disposal.

These safeguards may include:

• professional confidentiality requirements;

• confidentiality agreements;

• privacy training;

• restricted and role-based access;

• password protection;

• secure electronic record systems;

• safeguards for electronic transmission;

• secure paper-file storage; and

• secure destruction of records.

If a privacy breach occurs, the responsible Health Information Custodian will take appropriate steps to contain and investigate the incident, reduce further risk, notify affected individuals where required, and notify the Information and Privacy Commissioner of Ontario or other authorities when legally required.

Record Retention

Each clinician is responsible for retaining their clients' records in accordance with PHIPA and the requirements of their professional regulatory body.

Retention requirements may differ according to the profession, type of record, age of the client and nature of the service.

When records are no longer required to be retained, they will be securely destroyed or deleted in a manner appropriate to their format.

Access to Your Record

Under PHIPA, you generally have the right to request access to personal health information about you that is in the custody or control of your Health Information Custodian, subject to limited exceptions established by law.

Requests should normally be made to the clinician responsible for your record. If you are uncertain who is responsible for your record, the Pembroke Psychological Services Privacy Lead can assist in directing your request.

A formal request may be required in writing, and you may be asked to verify your identity and identify the records requested.

Formal access requests are generally answered within 30 calendar days, although PHIPA permits an extension in specified circumstances.

A reasonable fee based on permitted cost recovery may apply. Where a fee is charged, an estimate will be provided in advance.

PHIPA contains limited exceptions to the right of access. The statutory right of access also does not extend to certain raw data from standardized psychological tests or assessments.

If a formal request is refused in whole or in part, you will be given the reason for the refusal and information about your right to complain to the Information and Privacy Commissioner of Ontario.

Correction of Your Record

If you believe information in your record is inaccurate or incomplete, you may make a written request for correction to the Health Information Custodian responsible for your record.

The request should identify the information in question and the correction you are requesting.

PHIPA does not require every disputed entry to be changed. For example, a correction may be refused where the information consists of a professional opinion or observation made in good faith or another exception under PHIPA applies.

Where a correction request is refused, you will be advised of the reason and of the rights available to you under PHIPA, which may include requesting that a statement of disagreement be attached to the record and making a complaint to the Information and Privacy Commissioner of Ontario.

Use of Artificial Intelligence

Pembroke Psychological Services may use artificial intelligence (AI) or other technology-assisted tools only where their use is appropriate, privacy-protective, and consistent with applicable legal and professional obligations, including the Personal Health Information Protection Act, 2004 (PHIPA), the Personal Information Protection and Electronic Documents Act (PIPEDA) where applicable, and the standards of the College of Psychologists and Behaviour Analysts of Ontario (CPBAO).

Clinical Responsibility and Human Oversight

AI is not used as a substitute for clinical judgment, diagnosis, psychological assessment, psychotherapy, or other professional decision-making. Any AI-assisted content used in clinical or administrative work is subject to appropriate human review. The responsible regulated professional remains accountable for the accuracy, appropriateness, and professional quality of the services provided.

Privacy and Personal Health Information

Personal health information is not entered into public, consumer-facing, or otherwise non-secure AI platforms. Where an AI-enabled tool is used in a way that involves personal information or personal health information, Pembroke Psychological Services takes reasonable steps to assess the tool's privacy and security safeguards, limit information to what is necessary, and ensure that the use of the technology is consistent with Ontario privacy requirements and professional standards.

Transparency and Consent

Clients will be informed when AI or an external technology application is used in a manner that is relevant to their care or involves their personal information. The informed consent process will address the nature and purpose of the technology, material privacy or security risks, and the possibility of technological error. Written consent will be obtained where required by law, professional standards, or the circumstances of the service.

Questions or Concerns

Clients are welcome to ask how technology is being used in their care and what safeguards are in place to protect their information. Privacy Questions or Complaints

Questions or concerns about your personal health information may be raised directly with the clinician responsible for your care.

You may also contact the Pembroke Psychological Services Privacy Lead regarding privacy practices, administrative handling of personal health information, concerns about unauthorized access, use or disclosure, assistance identifying the Health Information Custodian responsible for your record, access or correction requests, or a privacy complaint.

Privacy Lead

Dr. Alisha Henson, Ph.D., C. Psych.
Pembroke Psychological Services

Email: admin@pembrokepsychology.com
Telephone: 613-735-9582
Address: 1219 Pembroke St. East, Pembroke, ON K8A 7R8

Where another clinician is the Health Information Custodian responsible for your record, the Privacy Lead may assist in directing your request or concern to that clinician.

Information and Privacy Commissioner of Ontario

You also have the right to contact or make a complaint directly to the Information and Privacy Commissioner of Ontario about the handling of your personal health information or your rights under PHIPA. You do not require permission from your clinician or Pembroke Psychological Services to do so.

Information and Privacy Commissioner of Ontario
2 Bloor Street East, Suite 1400
Toronto, Ontario M4W 1A8

Toronto: 416-326-3333
Toll-free: 1-800-387-0073
TTY: 416-325-7539

Updates to This Statement

This statement may be updated as privacy legislation, professional requirements, technology or the information practices used at Pembroke Psychological Services change.