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Privacy and confidentiality

Protecting patient information

Circle of care

Closed circle of care
  • The "circle of care" is the group of healthcare providers treating a patient who need information to provide that care.

Consent to share information with providers in the circle of care is generally implied. A patient who accepts a referral to another healthcare provider implies consent for sharing relevant information. This includes sharing with physicians and other healthcare providers who are caring for the patient, but does not include others such as family, friends, police, and so on.

Express consent
Express consent:  May be in oral or written form. It should be obtained when the treatment is likely to be more than mildly painful, when it carries appreciable risk, or when it will result in ablation of a bodily function.

Although orally expressed consent may be acceptable in many circumstances, frequently there is need for written confirmation. As health professionals have often observed, patients can change their minds or may not recall what they authorized; after the procedure or treatment has been carried out, they may attempt to take the position it had not been agreed to or was not acceptable or justified. Consent may be confirmed and validated by means of a suitable contemporaneous notation by the treating physician in the patient's record.

Express consent in written form should be obtained for surgical operations and invasive investigative procedures. It is prudent to obtain written consent also whenever analgesic, narcotic or anaesthetic agents will significantly affect the patient's level of consciousness during the treatment.
 is required to share information with others outside the circle of care.

Case: Sharing health information with family
Female physician speaking with young female patient


A father is scheduled to see you immediately following his 15-year-old daughter's appointment. At her visit, the daughter requests a prescription for the birth control pill (BCP).
Female physician speaking with middle-age male

Background continued

After taking her sexual history, counseling her about sexual health issues and explaining the risks associated with the BCP, you write out the prescription. During the father's visit, he asks you whether his daughter is sexually active.

Think about it

What would you tell him?


The father is not within the circle of care in this case. If a patient is able to provide informed consent for treatment, the patient should also authorize the release of her confidential health information.

An adolescent's expressed wish should be respected.


Only the province of Québec has an "age of consent," set at 14 years of age.

For more information see consent for minors.