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Lock-box Provision Procedure

Lock-Box Provision excerpt from Privacy Policy

Personal health information you share with us will only be shared with other healthcare professionals that you have identified as being a member of your healthcare team, except in the case of a medical emergency. Given the nature of the services provided by Samantha Holmgren Dietetic Services, such an exception would be exceedingly rare. If any other healthcare provider contacts us requesting personal health information about you, we will contact you to get your consent (or refusal).

You have the right to control what happens to your personal health information and whether said information will be shared with other members of your healthcare team. If you disclose information and do not want it shared, you can withhold or withdraw your consent for the disclosure of that information. This is referred to as a “lock-box provision”.

Your request may include restricting:

  • The use or disclosure of a particular piece of information
  • The use or disclosure of the content of your entire record
  • The disclosure of information to a particular individual, organization, or profession (e.g. nurse, doctor, etc.)

The information will still be stored in your record; however, it will be redacted in any records shared. If we believe that information is relevant to your care, we will include a note in the chart that states that information has been redacted under a lock-box provision. As such, the professional who receives your record may ask you about it.

The only exception to the Lock-Box Provision is when the dietitian is under an obligation to report the information being disclosed. For example, when there is reasonable grounds to suspect there is a significant risk of harm, health professionals (including dietitians) are obligated to report those concerns to the appropriate authorities.


  1. Any information that has been “lock-boxed” will have the following format. (To clarify, “information goes here” will be replaced with the relevant information.)

LOCK-BOX information goes here [details e.g. do not share with doctor] LOCK-BOX

Additionally, the note summary will state “Some information in this note is under a lock-box provision.”

2. In the case that the note is included in a report, the note will be duplicated and the lock-box will be replaced with the following:


    Additionally, the note summary will indicate that the note was duplicated and lock-boxed information redacted so that the note can be included in a report to the provider.

    If the client chooses to unlock information:

    It will be noted in the chart at the time when the client states that they wish to unlock the information. A second note will be created and back-dated so that it falls in the record near the original note.

    Record of Reviews

    DateReview TypeSummary
    April 9, 2024MinorFormatting for clarity; grammar updated
    December 6, 2021MinorUpdated grammar and added record of reviews
    November 9, 2021InitialFirst version of the procedure.