Clinic Policy Acknowledgement

Patient Information & Clinic Policies

Family Medicine Practice
Dr. O. Agoro, MD, MBChB, MRCGP, CCFP

Introduction

Thank you for registering with our family medicine practice. This document outlines clinic policies, expectations, and administrative procedures. These policies are intended to support safe, ethical, and effective medical care in accordance with professional standards and applicable legislation.

Patients are encouraged to review this document carefully. Questions may be directed to clinic staff or discussed with the physician during an appointment.

Scope of Care & Health Maintenance

This practice provides comprehensive primary care services with an emphasis on preventive health, including:

. Age-appropriate screening and immunizations

. Cancer screening based on current clinical guidelines

. Chronic disease management

. Lifestyle counselling related to nutrition, physical activity, and risk reduction

Preventive care is particularly important for patients with chronic medical conditions, a family history of illness, or advancing age.

Care Team

Care may be provided by:

. Your family physician

. Regulated and non-regulated clinic staff supporting clinical care

Medical learners may occasionally be present. Patients will be informed in advance and may decline learner participation. All learners are supervised and practise within defined scopes under physician oversight

Primary Care Relationship

By enrolling with this practice, patients are expected to use this clinic as their primary source of medical care whenever possible.

Use of walk-in clinics or external providers should be limited to circumstances where timely care is not available. When care is obtained elsewhere, the clinic may request medical records to support continuity of care. Any associated transfer or administrative fees are the responsibility of the patient.

Appointments & Office Hours

Physician availability is generally Monday, Tuesday, Thursday, and Friday from 9:00 AM to 5:00 PM, subject to change.

Appointments may be booked by phone or email. Clinical urgency will be assessed at the time of booking.

Patients are expected to:

. Provide the reason for the visit when booking

. Book additional time for forms, physicals, or paperwork

. Limit visits to one primary concern unless otherwise advised

. Allow flexibility for delays, as unforeseen clinical circumstances may arise Urgent or emergent concerns may be redirected appropriately.

Missed Appointments

. A minimum of 24 hours’ notice is required for cancellations

. A $50 fee applies to missed or late-cancelled appointments

. Repeated missed appointments may result in discontinuation of care

. Outstanding balances may limit future booking privileges

Prescription Management

. Prescription renewals generally require a scheduled appointment

. Pharmacists may provide limited emergency supplies at their discretion

. A $25 administrative fee may apply for urgent interim renewals when clinically appropriate

Virtual Care

Virtual visits are not routinely offered. When provided, they are based on clinical appropriateness.

By participating in virtual care, patients acknowledge:

. Potential limitations and privacy risks associated with virtual platforms

. The possibility that an in-person assessment may be required

Uninsured Services (Non-OHIP)

Certain services are not publicly insured. Examples include, but are not limited to:

. Missed appointment fees

. Completion of medical forms, letters, or documentation for third parties

. Travel advice, TB testing, injections, and minor procedures not covered by OHIP

. Transfer or copying of medical records

. Services provided without valid health coverage

Fees are consistent with Ontario Medical Association (OMA) guidelines and are payable at the time of service. Patients are encouraged to inquire about fees prior to requesting uninsured services.

Medical Records & Privacy

The clinic complies with the Personal Health Information Protection Act (PHIPA).

. Medical records are maintained securely and accessed only for authorized clinical purposes

. Implied consent permits information sharing within the patient’s circle of care

. Provincial databases (e.g., OLIS) may be accessed to support continuity of care

. Patients may request access to their records in writing; administrative fees may apply

. Requests to amend records require a clinical appointment

. Patients are responsible for keeping contact information current

Termination of the Physician-Patient Relationship

Patients may transfer care at any time by providing written notice to facilitate an orderly transfer of records.

The clinic may terminate the physician-patient relationship where clinic policies are repeatedly violated, professional boundaries cannot be maintained, or the therapeutic relationship has broken down. Immediate termination may occur in situations involving abusive, threatening, or fraudulent behaviour.

Reasonable Notice & Emergency Coverage

Where the physician-patient relationship is terminated, reasonable notice will be provided in accordance with professional obligations, except where immediate termination is required to ensure the safety of clinic staff, patients, or the physician.

During the notice period:

. Medically necessary care related to existing conditions may continue to prevent foreseeable harm

. Urgent issues may be addressed at the physician’s discretion

. Limited prescription renewals may be provided where clinically appropriate

. Patients are responsible for securing alternate primary care as soon as possible

This clinic does not provide emergency medical services.

Patients requiring urgent or emergency care outside clinic hours, or after termination of care, should attend the nearest emergency department or contact emergency services by calling 911.

Zero-Tolerance Policies

Abusive or Threatening Behaviour

Harassment, abuse, or threatening behaviour toward staff, patients, or clinic property—verbal, physical, or sexual—will not be tolerated and may result in immediate termination of care.

Fraudulent Activity

Falsification or misuse of medical documentation, prescriptions, or information constitutes serious misconduct and may result in permanent termination of care and referral to appropriate authorities.

By signing below, I confirm that I have read, understood, and agree to the clinic policies outlined in this document.

Physician:
Dr. O. Agoro, MD, MBChB, MRCGP, CCFP