Canadian Real World Consent Directive Scenarios by Pat Pyette

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Real World Consent Directive Scenarios

The following scenarios are based on existing jurisdictional policy and are realized in existing systems in Canada. The default policy is one of implied consent for the provision of care, so these scenarios all deal with withdrawal or withholding consent for that purpose. In other jurisdictions, where an express consent model is used (Opt-In), these would be express consent rather than withdrawal.

1) Withhold or withdraw consent for disclosure of records related to specific domain (e.g. DI, LAB, etc.)

   Eve Everywoman wishes to withhold disclosure of all of her lab orders and results to any provider. 
   

2) Withhold or withdraw consent for disclosure of a specific record (e.g. Lab Order/Result)

   Adam Everyman's Primary Care Provider, Dr. Philip Primary, has ordered a set of lab test which Adam 
   wishes to keep as private as possible.  At the sample collection facility, he indicates that he would 
   like withhold consent to disclose the order and all results associated with that specific order from 
   everyone except Dr. Primary. 

3) Withhold or withdraw consent for disclosure to a specific provider organization

   Adam Everyman's ex-spouse is a Physician that is employed by Good Health Clinic.  Adam decides
   that he would like to withdraw/withhold consent to disclose any instance of his health information 
   to Good Health Clinic.

4) Withhold or withdraw consent for disclosure to a specific provider agent (an individual within an organization)

   Eve Everywoman's ex-spouse, Bill T Lookafter is a Nurse that is employed by Good Health Hospital.
   Eve realizes that she may receive treatment at GHH, however she does not want her ex-spouse to have any 
   access to her IIHI.  She indicates that she would like to withdraw/withhold consent to disclose any instance 
   of her health information to her ex-spouse as a result of his employment at Good Health Clinic.

5) Withhold or withdraw consent for disclosure of records that were authored by a specific organization (or service delivery location).

6) Combinations of the above, such as withhold or withdraw consent to disclose all of my Labs to every organization except for Good Health Clinic and Sunny Ways Hospital, and then only allow disclosure of records 1234 and 4567.