College of Physicians and Surgeons of Manitoba Standards of Practice Regulation

College of Physicians and Surgeons of Manitoba Standards of Practice Regulation, M.R. 164/2018 The Regulated Health Professions Act , C.C.S.M. c. R117 Regulation 164/2018 Registered December 3, 2018 bilingual version (HTML) Table of Contents Section 1 Definitions 2 Accepting patients 3 Medical care 4 Practice environment and equipment 5 Collaborative care 6 Practice settings policies 7 Billing for meetings 8 Notice of billing for uninsured services 9 Responding to requests for information or opinion 10 Record of appointments 11 Patient records 12 Ending a member-patient professional relationship 13 Notice of intention to close, leave or move medical practice 14 Storage and disposition of patient records and supplies 15 Standards incorporated by reference 16 Practice directions 17 Coming into force Definitions 1 The following definitions apply in this regulation. "Act" means The Regulated Health Professions Act . («  Loi  ») "college" means the College of Physicians and Surgeons of Manitoba continued under clause 8(b) of the Act. (« Ordre ») "health care professional" means a person who engages in health care as a practising member of a health profession regulated under the Act or a profession-specific Act listed in Schedule 2 of the Act. (« professionnel de la santé ») "medical care" means any health care that a member provides in the course of his or her practice as a member. (« soins médicaux ») "member" means a regulated member or regulated associate member of the college. (« membre ») "patient record" means a record containing the information described in section 11 (patient records). (« dossier du patient ») "representative" means a person referred to in section 60 of The Personal Health Information Act . (« représentant ») "virtual medicine" means the provision of medical care by means of electronic communication where the patient and the member are at different locations, including but not limited to treating, advising, interviewing or examining the patient. (« médecine virtuelle ») PART 1 MEDICAL PRACTICE Accepting patients 2(1) If a member restricts or selects patients for his or her practice, or has a practice that is closed to new patients, the restrictions or selection criteria for accepting patients must be relevant to the member's clinical competence and medical practice and to a patient's health care needs. 2(2) In special or exceptional circumstances, a member may accept as a patient a person who does not meet the criteria or falls outside the restrictions for accepting patients established under subsection (1). 2(3) If a member meets with a person seeking the member's medical services and does not accept the person as a patient, the member must explain the reason to the person, unless disclosure of the reason could, in the opinion of the member, be reasonably expected to (a) threaten the person's mental or physical health or safety; (b) threaten another person's mental health or physical health or safety; (c) breach the privacy of another patient; or (d) pose a threat to public safety. Medical care 3(1) A member must provide good medical care to a patient and include in the medical care that he or she provides (a) an assessment of the patient that includes the recording of a pertinent history of symptoms and psychological and social factors for the purpose of making an appropriate diagnosis, when required; (b) the physical examination of the patient that is required to make or confirm a diagnosis; (c) the consideration of the patient's values, preferences and culture; (d) sufficient communication with the patient or his or her representative about the patient's condition and the nature of the treatment and an explanation of the evidence-based conventional treatment options, including the material risks, benefits and efficacy of the options in order to enable informed decision-making by the patient; (e) timely communication with the patient about the care; (f) a timely review of the course and efficacy of treatment; (g) the referral of the patient to another member or health care professional, when appropriate; and (h) the documentation of the patient record at the same time as the medical care is provided or as soon as possible after the care is provided. 3(2) For the purpose of clause (1)⁠(d), "material risks" are to be determined by the member having consideration for the special circumstances of each patient and the potential seriousness of risk for a reasonable person in the same circumstances. Practice environment and equipment 4(1) A member may engage only in medical care that, in the member's reasonable and professional judgment, is safe, appropriate and sanitary. 4(2) A member must take reasonable steps to ensure that a system is in place for the proper maintenance, cleaning and calibration of equipment used in the medical care he or she provides. Collaborative care 5 When a member and one or more other health care providers are involved in the health care of a patient, the member must (a) collaborate with other health care providers in the care of the patient and in the functioning and improvement of that health care; (b) treat other health care providers with respect; (c) recognize the skills, knowledge, competencies and roles of others involved in the patient's care; (d) understand the member's role and the role of other health care providers involved in the health care of the patient; (e) identify himself or herself to the patient or his or her representative and explain the member's role and responsibility; (f) communicate effectively and appropriately with the other health care providers; and (g) document, on the patient record, the member's contribution to the patient's care. Practice setting policies 6 A member must comply with any policy about the performance of any reserved act or the provision of collaborative care that is in place in the practice setting where the member is involved in the health care of a patient if (a) the member has been made aware of the policy; and (b) the policy is not inconsistent with the Act or the college's regulations, standards of practice, by-laws, practice directions or code of ethics. Billing for meetings 7(1) If a meeting between a member and a person seeking his or her medical services is not a medical appointment, the member must notify the person of that fact. 7(2) A member must not submit a claim under The Health Services Insurance Act , or charge any person, for making an appointment to meet or for meeting with a person to determine if he or she will be accepted as a patient. 7(3) If medical care is provided by the member in the course of a meeting with the person, the member may submit a claim under The Health Services Insurance Act if authorized to do so by that Act. Notice of billing for uninsured services 8 Before medical care that is not an insured medical service under The Health Services Insurance Act is provided to or for a patient by a member, the member must notify the patient of any fee or charge the patient will be required to pay. This requirement does not apply if the member is providing emergency care and it is inappropriate or impossible to notify the patient. Responding to requests for information or opinion 9(1) A member must provide details of his or her assessment, diagnosis, advice and other medical care provided to a patient when requested to do so by the patient, the patient's representative or lawyer, or if required by law. 9(2) Notwithstanding subsection (1), a member is not required but is encouraged to provide, at the request of a patient or his or her representative or lawyer, (a) a medical-legal opinion; (b) an expert opinion; or (c) expert evidence in a legal proceeding. PART 2 PATIENT RECORDS, ENDING A PROFESSIONAL RELATIONSHIP AND CLOSING A PRACTICE Record of appointments 10(1) A member must keep a record of his or her appointments with patients and those persons seeking medical care indicating, for each day, the names of persons seen and patients for whom medical care was provided. 10(2) The record of appointments must be retained by the member, or another member who has possession of them, for at least 10 years after the date the record was made. Patient records 11(1) A member must appropriately document the provision of patient care in a record specific to each patient. 11(2) A member must document on the patient record the medical care given to the patient containing enough information for another member to be sufficiently informed of the care provided. 11(3) A patient record must be retained by the member having last custody of the record for at least 10 years after the date of the last entry on the record, and patient records of minors must be retained for at least 10 years after the date the minor becomes 18 years old. 11(4) For greater certainty, a member who provides medical care by virtual medicine must comply with this section. 11(5) A member must retain control of all of his or her patient records unless they are maintained (a) by another member; or (b) by a person or organization that employed, engaged or granted privileges to the member and is a trustee under The Personal Health Information Act . 11(6) The obligations under this section are in addition to any other requirements relating to patient records under the Act, The Personal Health Information Act , and any other enactment, by-law, standard of practice, code of ethics and practice direction with which a member must comply. Ending a member-patient professional relationship 12 A member who ends a professional relationship with a patient must give notice to the patient or his or her representative, have reasonable grounds for doing so and must document those reasons on the patient record. Notice of intention to close, leave or move medical practice 13(1) A member must give notice of the member's intention to close their medical practice, to take a leave of absence or to relocate their practice or otherwise cease to practice medicine in Manitoba to (a) the member's patients or their representatives; (b) the college; (c) other members with whom the member refers or consults; (d) the Department of Health, Seniors and Active Living; (e) any regional health authority in which the member has privileges; (f) a personal care home at which the member has privileges that is not operated by a regional health authority; (g) if applicable, the Canadian Medical Protective Association; (h) Doctors Manitoba. 13(2) The notice must include (a) the date of closure, absence, relocation or other cessation of practice; (b) information about where the patient's records are to be located and how the records can be transferred to another member or how copies of the records can be obtained; and (c) particulars of any arrangements for medical care that have been made for the member's patients. 13(3) Clause 2(b) does not apply if the patient records are maintained by a trustee under The Personal Health Information Act who employed, engaged or granted privileges to the member. Storage and disposition of patient records and supplies 14(1) A member who closes their medical practice or takes a leave of absence must (a) ensure the secure storage of any patient records for the remainder of the retention period required by subsection 11(3) and the retention of appointment records for the remainder of the period required by subsection 10(2) and the subsequent destruction of the information in accordance with The Personal Health Information Act ; and (b) give the college a copy of the notice sent to patients and information about to whom the notice was sent and the arrangements that have been made for the secure storage of the patient records and appointment records. 14(2) A member who ceases to engage in medical practice, temporarily or permanently, or who closes a medical practice, must safely dispose of medications, laboratory specimens, equipment and supplies. 14(3) The obligations under this section are in addition to any other requirements relating to patient records under the Act, The Personal Health Information Act , and any other enactment, by-law, standard of practice, code of ethics and practice direction with which a member must comply. PART 3 MISCELLANEOUS MATTERS Standards incorporated by reference 15 In addition to this regulation, a member must comply with those standards established and published by the college entitled "Standards of Practice of Medicine", as amended by council from time to time. Practice directions 16 Nothing in this regulation limits or restricts the council of the college from issuing practice directions under section 85 of the Act to enhance, explain, add to or guide members with respect to the subject matters described in this regulation or any other subject matter relevant to the practice of medicine. Coming into force 17 This regulation comes into force on the same day that section 179 of the Act comes into force.