Dr Howard Schneider
Dr Howard Schneider

Circle of Care



What is the "Circle of Care"?

'The "circle of care" is not a defined term under PHIPA (Personal Health Information Protection Act). It is a term of reference used to describe health information custodians and their authorized agents who are permitted to rely on an individual's implied consent when collecting, using, disclosing or handling personal health information for the purpose of providing direct health care.'


In my practice, your circle of care includes:

  • Your Family Physician and their assistants who help them carry out their day to day work
  • My assistants (although I am very careful to limit information about your case as much as I can to my assistants; I try to disclose only what is minimally required; for example, the billing administrator only sees a billing code, not your entire chart)
  • Specialists or other health care providers referred by the physician -- in particular, psychiatrists or neurologists who are providing care to you, or psychiatrists I refer you to for additional opinions
  • Health care professionals or other individuals selected by the patient


The purpose of the 'Circle of Care' is to ensure that you receive the best care and continuous care. 


I will send copies of my consultations and reports to your referring physician (usually your family physician) so that he or she is aware of my diagnostic impressions and treatments. If your condition improves and becomes stable, then I will usually send reports less often, but still will send occasional reports. In any case, if your physician requests any information from me, I will attempt to provide it immediately or with the shortest delay that is practical. No express consent is required for me to do so to members of your 'Circle of Care'.  Reports are sent by fax where possible, but if the report is too large, it will be sent by Canada Post to your family physician.




Why do I need a referral to see you?

A referral from (usually) your regular family physician is required to see me so that the Circle of Care becomes established from the start.


I am running out of medication and I can't see you tomorrow. What should I do?

I am careful to synchronize medications with appointments you have with me, and to give you a small additional buffer amount. However, if you miss appointments and then do not rebook soon enough or are unable to rebook soon enough, you may run out of medication.

To prevent this:

1. See your Family Physician immediately. He/she is part of the 'Circle of Care'. He/she has received reports from me (or if not, information will be sent immediately or with the shortest delay possible) and can refill your medication.

2. Speak to your pharmacists. The pharmacists now have the ability to refill medication and may be willing to do this for a short period of time, although I realize for psychiatric medication many pharmacists are unwilling to do so. However, the pharmacist can fax me for permission to extend your prescription.

3. Make sure you have rebooked your appointment with me and try your best to come to the appointment.


I am feeling terrible and I cannot contact you at all. What should I do?

1. See your Family Physician immediately. He/she is part of the 'Circle of Care'. He/she has received reports from me (or if not, information will be sent immediately or with the shortest delay possible) and can often help in these situations, or if not, can direct you to the ER.

2. Go the ER ('Emergency Room', 'Emergency Department') of your local hospital.  Almost all the hospitals have mental health teams who will help you. In the majority of cases you will not be hospitalized, but you will receive some short term help, and someone from the hospital will eventually contact me and we can all collaboratively work on a solution for you. In some cases, hospitalization is necessary, but generally every effort is made to keep hospitalizations to the shortest period possible, and to ensure that you return to a functional life.



1. I do not release information to individuals outside of your 'Circle of Care'. Please keep in mind that your husband or wife or mother or father, is generally considered to be outside of your 'Circle of Care' unless you have specifically given me permission, either in writing, or implicitly, eg, they attend sessions with you.

2. Consent is considered implied for your 'Circle of Care'. 

3. As noted above, for those outside of your 'Circle of Care', I do not release information. If your lawyer or insurance company telephones me, I unfortunately cannot release any information. I know this frustrates people when they want and need information quickly and are actually doing so with good intentions. However, without your permission, I cannot provide this information. You must provide a consent for me to release information as such. As well, it is preferable that all information I release is written, ie, there are security issues with providing information over the phone or on the Internet.

4. Like many physicians I recognize the value the Internet has in providing communication with yourself and with others you wish me to communicate with. However, at this point in time, until security issues are better worked out, I do not use social media with patients, and e-mail with me is really intended for short messages, not for management of your care. You must see me in person for your care -- please do not rely on e-mail. (Perhaps in the future this will change, but at this time, you must see me in person for care.)

5. Like many physicians I recognize that recordkeeping has evolved over the years, and I make use of electronic devices to ensure that records concerning you as my patient are professional and meet the professional requirements I am expected to follow. At present the electronic computer system I use is not attached to any commercial system, and I keep your files encrypted and offline. However, I reserve the right to use commercial systems, most which have online features these days, in the future, as most physicians at present do. Also, the ability of electronic/computerized devices to automate the production of medical records is evolving, and I make use of this technology to some extent at present. Please note that only the written medical record is kept as your medical record. Any keystroke input or voice input to tablets or to the main computer system which can be used to create medical records, is not kept but is double encrypted preventing retrieval and eventually discarded.

6. I make every reasonable effort to physically protect your paper chart, and to encrypt any electronic chart recordings. However, please realize that after I release information to another party, I no longer have control over it. Generally, members within your Circle of Care, such as your family physician, will be required to make the same efforts with regard to the privacy of your health information.

7. If you have any concerns, please feel free to discuss them. Please, however, keep in mind that I am obligated to create medical records and I am obligated to communicate with the referring physician.
8. I cannot provide medical information via email requests. If you are a former patient I have no assurances that it is even you on the other side of the email. Please note that I send reports to your family physician who referred you to me -- medical information should be available from your family physician. If there are requests for information directly from me, please use standard, written request forms for medical information which must be mailed to me (email is not possible due to security issues). There are standard charges associated with this for the time involved in preparing this paperwork (versus no charge for me to send information to your family physician). If there is a request to send information to a non-physician office address, written, guaranteed (e.g., adequately witnessed, with supporting documentation) proof that this is your address will be required. Medical records are kept for 10 years from the last session/medical advice (or in the case of children would have reached 18 years old) and then securely disposed (as per 2022 regulations).