Records of programs and services supporting the health and wellness of University community members.
This records class includes Personal Information Banks.
Related Records | Responsible Unit | Information Steward | Information Confidentiality Classification | Retention | Disposition | Authority | Retention Rationale | Personal Information Banks | Version Information
Content & Scope
Campus Wellness provides primary medical care and mental health services for registered students. Clients may also include University faculty and staff. The Centre for Mental Health Research and Treatment (CMHRT) conducts mental health research, provides mental health services to people of all ages in the Region of Waterloo, and offers clinical training to Ph.D. students in Clinical Psychology. Athletic health and therapy services are provided to University athletes by a team of certified athletic therapists and student therapists. Athletes may also be assessed or treated by a physician. Occupational health nurses support employee health by providing support to employees during illness or injury-related absences or return to work, and by providing counselling or referrals to Employee Assistance Program providers. Occupational Health also ensures that the needs of employees with disabilities are accommodated appropriately.
This class excludes records of services and accommodations for students with disabilities.
Client records include: client profiles, contact information, and health history; assessment, test, diagnosis and treatment records; session notes; referrals; incident and injury reports for Waterloo and visiting students; information on crises or critical incidents; billing and payment records; and related correspondence.
Program and service records include: promotional information on programs and services; health and wellness educational/learning resources; administrative records associated with planning, organizing and offering workshops, events and other services; workshop/event participant profiles and registration information.
Related Records
For records of services and accommodations for students with disabilities, see HS15 – Services for Students with Disabilities.
Responsible Unit
- Campus Wellness.
- Athletics & Recreation.
- CMHRT.
Information Steward
- Dean of the Faculty of Arts, for CMHRT records.
- Associate Provost, Students, for all other records.
Information Confidentiality Classification
- Public: health and wellness educational resources, promotional information on programs and services, and other information intended for public release.
- Highly Restricted: client case records.
- Restricted: workshop/event participant profiles and registration information.
- Confidential: all other records.
Retention
- Health Services patient records: minimum of 15 years after last entry in record, or 15 years after reaching the age of 18 for those under age 18 when last entry was made.
- Counselling and psychotherapy client records: unless otherwise required by law, 10 years after last contact or 10 years after 18th birthday for clients under 18 at the time of last contact.
- Audi or video recordings of counselling sessions should be securely destroyed as soon as requirements related to supervision of interns and other trainees have been satisfied.
- Occupational health records for individual employees: the earlier of 5 years after the person's death or the year following the 90th anniversary of the person’s birth.
- Athlete health and therapy records: 10 years after last entry.
- Workshop/event participant profiles and registration information which are not required as part of individual clients’ records: minimum of 1 year after last administrative use. Units should document the specific retention period that they are using for these records (contact the University Records Manager for assistance, if required).
- Other program and service records: minimum of 2 years and not more than 7 years after last administrative use. Units should document the specific retention periods within this range that they are using for these records.
Disposition
Secure Destruction.
Note
Responsible Units should document the disposal/destruction of official records using the University records destruction form or equivalent documentation, to verify that we are following our records retention rules.
Authority
- University of Waterloo Act, 1972.
- O.Reg 114/94 under the Medicine Act, 1991.
- Psychology Act, 1991.
- Regulated Health Professions Act, 1991.
- Nursing Act, 1991.
- Workplace Safety and Insurance Act, 1997.
- College of Psychologists of Ontario Standards of Professional Conduct, section 9.
- College of Nurses of Ontario. Practice Standard: Documentation
Retention Rationale
Retention of patient records is based on the recommendation of the College of Physicians and Surgeons of Ontario and legal advice. Since athlete therapy files may contain medical records, their retention is based on O. Reg. 114/94, s. 19 (1) under the Medicine Act, 1991, which specifies a minimum retention period of 10 years after last entry. Retention of counselling and psychotherapy client records is based on The College of Psychologists of Ontario Standards of Professional Conduct, Section 9.4. Retention of occupational health records is based on the absence of a time limit for filing an occupational disease claim with the Workplace Safety and Insurance Board.
Personal Information Banks
[This section is under development]
Athlete therapy, counselling and psychotherapy, medical care, and occupational health client records are personal information banks.
Under Review Date
13 March 2020
Previous Version
19 December 2011
(This records retention schedule replaces HS20 – Athlete Therapy Files, HS22 – Counselling and Psychotherapy Client Files, HS24 – Medical Charts, and HS25 – Occupational Health Charts)