Information Sharing Agreement

This Information Sharing Agreement (ISA) template is for the benefit of physicians sharing patient Health Information within an Electronic Medical Record (EMR). Physicians should review this document thoroughly before signing. It is intended to be customized to accord with each clinic’s individual requirements.

The requirement to have an ISA in place is compliant with the College of Physicians and Surgeons (CPSA) Standards of Practice Regarding Patient Record Retention effective January 2016:

(3)  A regulated member acting as a custodian who shares patient information with other custodian(s) must have an information sharing agreement that clarifies access, transfer and return of patient records.

This ISA addresses the custodians’ obligations by:

• Ensuring that physicians are guided to use or disclose health information only if necessary, and using the minimum amount of information required for the purpose;
• Creating principles for the collection, use, and disclosure of health information (Article 2); 
• Describing primary and secondary uses and disclosures of health information (Articles 3.1.20 through 3.1.23); 
• Clarifying the requirement to maintain confidentiality and privacy (Article 6); and,
• Confirming what happens with health information should a physician leave a clinic (Article 4.5 and Appendix A).

It also emphasizes the need for a Dispute Resolution Process (Article 12) should differences arise relating to physicians’ use or disclosure of health information.

As custodians of health information, physicians are responsible for ensuring the privacy, confidentiality, and security of their patient’s information. This agreement is one of the tools which will allow physicians to do that.

Instructions for Use

These instructions will assist you with making this document your own and to and to fulfill your obligations under the Health Information Act. 

• At the top of the first page fill in the effective date of the agreement. Also, fill in the description of the practice (legal name) or clinic name. 
• The body of the agreement is standard. Please read the principles in Article 2 as they relate the agreement to the Health Information Act.  
• Definitions section: please fill out the date of the agreement (p.6) 
• Articles 4, to 13 describe the terms of the agreement. All signatories signal that they are in agreement with the terms.  
• Signature page (p.11): all physicians in the clinic must sign the agreement.
• See Appendix A, to determine the conditions should a custodian in the agreement leave the clinic.

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