Webinar FAQs and Materials

Yes, Google reviews may be considered as testimonials. Even if the information is provided anonymously, it can still qualify as a testimonial. These are often subjective statements from a patient or other individual expressing an opinion about the nature or quality of the member’s services. As such, testimonials may mislead the public.

The College recognizes that members do not have control over third party websites such as RateMD, Yelp or Google. If the member becomes aware that a testimonial is on a site, the member must make all reasonable efforts to have the testimonial removed.

A reasonable step would be to contact these websites and keep a record of your attempts in the event that the College inquires about the advertising. For example, RateMD has an email where concerns can be reported.

Members are expected to use their titles and designations when acting in a professional capacity, e.g. in advertising, and on business cards and invoices.

The titles and designations that each class of registered members may use are set out in the College’s Registration Regulation. Only qualified practitioners who meet the requirements of the College are authorized to use these titles and designations.

However, practitioners cannot use the College logo in their promotional materials or other business documents. The logo is the property of the College and is only to be used for College matters.

Members must advertise and practice the profession using the name they have registered with the College.

If a member has created a Professional Corporation, they can use a name other than the registered name of the Professional Corporation in its advertising. However, the name of the Professional Corporation must also be listed in the advertising. This ensures that members of the public are fully informed about the Professional Corporation.

You will need to send an email to the Registration department with the name that you would like to have listed as your common name used in practice. Once updated, your common name will also appear on the College’s public register.

No, a member who has obtained a Ph.D. may not use the Doctor title or designation in the course of providing or offering healthcare. Under section 33 of the Regulated Health Professions Act, 1991 (RHPA), no one is allowed to use the title “doctor”, its variation or abbreviation or an equivalent in another language when providing or offering to provide health care in Ontario, unless he/she is a member of:

• the College of Chiropractors of Ontario;
• the College of Optometrists of Ontario;
• the College of Physicians and Surgeons of Ontario;
• the College of Psychologists of Ontario;
• the College of Naturopaths of Ontario (with the ND designation following their name); or
• the Royal College of Dental Surgeons of Ontario.

Note that if the member is not in a clinical setting (i.e. if they are teaching) then it would be permissible to use the “Dr.” title. This is because there is no confusion that the member is offering or providing healthcare.

While the College recognizes that some members may receive training in a specialized field and that a large number of their clients may present with similar conditions, members must not advertise that they are specialists in an area.

An example of an acceptable language for advertising experiences would be to state that “Conditions we have treated include: a, b, c…”

No. Members may not provide before and after photos of how one’s services improve a patient’s appearance, as this is inherently misleading and unverifiable.

Similarly, different patients may react differently to the same treatment. Given these circumstances, posting of before and after pictures would be inappropriate as it will provide a false impression and/or expectation from the patient that a certain treatment will yield a certain result.

Many members use social media in their private and professional lives. It is important to recognize that in the context of social media, the line between personal and professional life may not be obvious. Social media, such as Facebook, Twitter or Instagram, are public-facing platforms even when used for personal reasons.

When using social media, members are advised to follow the same rules that would apply to any other form of communication; for example, by maintaining professional boundaries, protecting patient confidentiality and communicating respectfully and professionally.

Members should refrain from providing services to a person with whom they have a close personal relationship, such as a family member, friend, relative, or business partner, except in an emergency or if there is no other option available for the required service.

The practitioner-patient relationship involves a power imbalance in favour of the practitioner. This is why it is not recommended for the practitioner to treat other members of their family, as the practitioner will likely be unable to discharge their fiduciary duty in light of the emotional connection to the patient.

Members must never treat a spouse or a person with whom they have a sexual relationship, except in an emergency.

While treating an acquaintance may be acceptable under certain circumstances, practitioners need to be mindful of possible dual relationships. A dual relationship is where the patient has an additional relationship with the practitioner other than just as a patient (e.g., where the patient is a relative of the practitioner). Any dual relationship has the potential for the other relationship to interfere with the professional one.

It is best to avoid dual relationships whenever possible. The rationale for this is that members of the profession must always place the interest of the patient before their own. By taking the step to avoid dual relationships, members ideally will mitigate the risk of being placed in a situation where they may be motivated by other interests over the genuine health care needs of their patient.

Giving and receiving gifts can be potentially risky to the practitioner-patient relationship, as it may be considered a boundary violation. In some circumstances, for example, a gift that is of significant monetary value could lead the patient to believe a personal relationship is being formed with the practitioner. Practitioners should be careful about accepting gifts from patients in general. However, there are some situations in which it may be acceptable to do so, for example, when a patient brings a small New Year’s gift to their December appointment (gifts of nominal value where the financial value is small).

Practitioners must also be sensitive to the patient’s culture, where in some situations, refusing a gift could be considered an insult.

Maintaining professional boundaries is about being reasonable in a specific situation or context. It can be a delicate balance between maintaining a suitable professional distance and being engaged with the patient.

Practitioners should be mindful of accepting "friend" requests from patients on personal social media accounts. A practitioner must be careful to act as a professional health care provider, and not as a friend, to patients. Becoming too personal or too familiar with a patient is confusing to patients and will make them feel uncomfortable.

Practitioners may want to consider having a professional social media account that is separate from their personal account.

Whenever something occurs that could lead to a boundary violation, practitioners need to quickly address it. This may mean that a practitioner has a conversation with the patient to explain that dating a current patient is inappropriate and unprofessional.

However, there may be instances where a member finds that professional boundaries cannot be maintained. Practitioners must take these steps to end the patient-practitioner relationship:

1. Provide notice to the patient of the decision.

2.Help the patient find another practitioner.

3. Explain the fees for providing the patient with a copy of their record or transferring a copy to their new practitioner.

Dating former patients is a sensitive issue. Under the Health Professions Procedural Code, practitioners must not engage in sexual relations with a patient or engage in sexual behaviour or make remarks of a sexual nature towards patients. The Code requires that a one-year cooling off period between the termination of the professional relationship and when a sexual relationship can begin.

After the one-year period, it is not sexual abuse because the person is no longer the practitioner’s patient. However, it can still be unprofessional where the practitioner still has power over the patient even after a year has passed. Again, the rationale behind this concept is that members of the profession must always place the interests of their patient before their own.

Practitioners have a legal duty as a regulated health professional to report certain information about yourself and/or your practice to your regulatory College.

In some situations, you have a duty to report other regulated health practitioners to their professional colleges or to an appropriate authority. For example, you are working in a multidisciplinary clinic and have reason to believe that another regulated health professional has sexually abused a patient. In that case, you must file a written report to the Registrar of the college that regulates that professional.

This is called mandatory reporting. By doing your duty to report, you help the College meet its mandate to protect the public. You also help maintain the integrity of the profession.

For more information on Mandatory Reporting Requirements, please refer to the College’s Educational Tip.

For a regulated health profession to obtain an exemption, they need to submit a regulation amendment to the Ministry of Health. The Ontario Government will then consider whether to grant the exemption or not.

Practitioner’s need to consider the potential risks of self-disclosure (pg. 21 of the Jurisprudence Couse Handbook explains):

“When a practitioner shares personal details about his or her private life, it can confuse patients. Patients might assume that the practitioner wants to have more than a professional relationship. Self-disclosure suggests that the professional relationship is serving a personal need for the practitioner rather than serving the patient’s best interests. Self-disclosure can result in the practitioner becoming dependent on the patient to serve the practitioner’s own emotional needs, which is damaging to the relationship.”

The responsibility for setting boundaries in the patient-practitioner relationship rests with the member. Each patient’s boundaries will be unique to their own experiences, including their culture, gender, age, beliefs, values, and sexual identity. However, it would be up to the practitioner’s discretion what they wish to disclose to their patients regarding their personal life.

Depending on the situation that arises, this may mean that a practitioner has this conversation early on with their patient, to establish that they do not discuss with patients their personal information. Practitioners may need to remind their patients of this (in a nice and respectful manner), so that they are clear on what the boundaries are.

Telepractice may provide opportunities for more informal types of interaction, which may lead to potential boundary crossings. For example, suppose a practitioner allows for text messaging with patients. In that case, they should carefully consider their expectations of how and when they will use and respond to text messages from their patients. Members will also want to remember and consider how these text messages are incorporated into the patient record.

Practitioners should also pay attention to the environment where telepractice will occur and avoid any personal items that may increase the risk for boundary crossings or violations.

Members can refer to the Telepractice Guideline for more information.

Patients may not be aware that the diagnosis of mental health conditions is a controlled act that is not authorized to members of the College. Practitioners would need to explain that counselling/therapy is outside of the scope of TCM practice. While treatment of and diagnosis of mental health conditions is a controlled act, the practice of traditional Chinese medicine involves the assessment of body system disorders through traditional Chinese medicine techniques. As such, practitioners may, under certain circumstances be able to alleviate symptoms of anxiety, depression and stress through traditional Chinese medicine therapies to restore balance to the body system.

As with any treatment provision, members must follow the Standards of Practice, guidelines, and ensure that they have the competencies (knowledge, skill and judgment) to provide safe and effective care to their patients.

Some online resources are included below that may provide patients with additional information for further support:

• https://www.toronto.ca/community-people/health-wellness-care/covid-19-wellness-during-the-pandemic/covid-19-mental-health-resources/

•https://theworkingmind.ca/sites/default/files/twm_self-care-resilience-guide.pdf

• https://www.camh.ca/en/health-info/guides-and-publications/looking-for-mental-health-services

• https://www.ontario.ca/page/find-mental-health-support

If the patient would like to see a regulated health professional for mental health (e.g., family doctor, psychiatrist, psychologist, etc.), the Health Professions Regulators of Ontario (HPRO) website has a list of the regulatory bodies. All the colleges have a public register for member lookup.

Practitioners who practice in more than one regulated health profession must maintain separate patient records. Practitioners are expected to ensure that it is clear to their patients (and third parties, e.g., insurance companies) what profession they are practising at any given time and what type of service they are providing in that capacity.

For example, a CTCMPAO member who is also registered with the College of Massage Therapists of Ontario (CMTO) must maintain two completely independent patient records, one for TCM/Acupuncture and one for Massage Therapy.

Similarly, financial records for each profession must be maintained separately.

When a practitioner retires or leaves the practice (i.e., resigns as a member of the College), the original patient records must be kept for the ten-year retention period (unless the records have been transferred to another practitioner who will maintain the records).

The member needs to ensure that the patient has access to the patient chart for the ten-year window. This will require the member to maintain the patient chart in a safe and protected manner. It will also require the member to ensure that patients know who to contact if they wish to obtain their patient chart.

The Office of the Information and Privacy Commissioner of Ontario recommends custodians implement a succession plan to address changes in practice and prevent abandoned records. For more information, please see the Succession Planning to Help Prevent Abandoned Records Fact Sheet.

Also, as outlined in the College’s Safety Program Handbook, if there is a situation where the practitioner, using professional judgment, decides to terminate the practitioner-patient relationship, it must be done carefully and thoughtfully in order to ensure the health of the patient and the continuity of care needed for the patient. The practitioner must provide written notification to the patient, outlining the specific reasons for termination and the date that care will be terminated. This written notification must also be retained in the patient record. If applicable, the practitioner must identify the need for continued care and establish processes to allow for the efficient transfer of records to the new practitioner. 

You may wish to inform your patients of the availability of alternate members, which can be done by, for example, referring the patient to the College’s public register or providing them with other members’ contact information.

In situations where clinic staff maintain the cleaning schedules and records, practitioners are not required to keep a separate log. However, practitioners should be able to access these records when required. Practitioners also need to ensure that the cleaning and its regularity complies with the expectations of the College. Therefore, practitioners will want to ensure that designated staff members are fully informed as to what is required. At the end of the day, regulated members are responsible for this to occur.

Members must retain traditional Chinese medicine herbs and equipment records for five (5) years from the date of the last entry in the record.

A record should be kept of the inventory of herbs that includes:

• identity of the herbs purchased
• name of the wholesaler
• country of origin (to manage any recalls due to adulteration of specific species)
• date purchased

When a prescription is dispensed, a record (or copy) of the prescription must also be kept on file. This record must include:

• ingredients of the prescription and amounts (should be on the copy of the prescription if it was made)
• date the prescription was dispensed
• number of packets dispensed
• name and contact details of the prescribing practitioner (should be on the copy of the prescription if it was made)
• name of the dispenser

For more information, please refer to Section 5 - Safe Procedures and Processes: Herbology of the Safety Program Handbook.

Members must retain patient health and financial records for ten (10) years from the date of the last patient visit.

For patients who are minors, records must be kept for ten (10) years after they turn 18.

Record keeping is an important part of every member’s practice. Members must maintain comprehensive records for every patient.

In some instances, there may be fees associated with record keeping. For example, when members transfer patient care to another provider, there may be costs for photocopying or scanning patient files.

However, members cannot charge patients for storing their records. That is a professional responsibility, and the cost must be assumed by the member.

The treatment record templates can be formatted to suit your practice needs. All diagnostic methods must be noted in the patient’s record. You may wish to include another section on the form to capture additional examination information. Accurate, clear and concise documentation helps to facilitate follow-up treatment and prevents error.

While records may initially be recorded in a language other than English or French, members must also translate their records into English or French soon after the original record is made. The College's Standard for Record Keeping states that records must be translated into one of the two official languages in a timely manner. This requirement applies to the entire patient record.

Members must be aware that requests for records can come at any time (from the College, other health care providers in an emergency, law enforcement, etc.), and it is the member’s responsibility to respond to those requests without delay. Failing to respond to a request for records in a timely manner because the records have not been translated could be considered a breach of the standard of practice. Therefore, members must have a procedure for translating records that allows them to respond to unexpected requests for records.

The College does not have a template for a privacy policy for clinic use.

The following list of resources below may be useful for practitioners or clinics that wish to develop a privacy policy:

• Office of the Information and Privacy Commissioner of Ontario
• Personal Health Information Protection Act, 2004
• Health Care Consent Act, 1996

The College cannot recommend specific record keeping software. However, for records kept electronically, there must be backup files and restore protocols in place. Access to the computer records must be secured via password to avoid tampering.

The practitioner is responsible for the safety and care of the electronic files to avoid privacy breaches. This includes accountability in how the electronic files are stored (e.g., location of servers, local backups, and cloud storage).

The Office of the Information and Privacy Commissioner of Ontario has information on safeguarding personal health information stored electronically.

Generally, every patient has a right to access his or her own personal health information unless an exception applies. [For example, if access would significantly jeopardize the health or safety of a person. The Personal Health Information Protection Act, 2004 (PHIPA) section 52. includes a list of the exceptions].

Practitioners are expected to retain original patient records. If a patient requests access to their health records, members may provide a copy (photocopy or electronic) of their records to them and notify them of any associated fees.

Remember, practitioners must retain patient health and financial records for 10 years from the date of the last patient visit.

No, only the names of the practitioner and others involved in the care of the patient need to be included on the treatment invoice.

Members must provide receipts that accurately reflect the service provided and/or product sold. Receipts must clearly identify the member who provided the treatment. A record of receipts issued and payments received form the financial record.

Financial records must include receipts and/or invoices for any treatment, product, or administrative fee (e.g., appointment cancellation fee) a patient has been charged.

Members are reminded that receipts must be provided after each treatment. It is not acceptable to issue block receipts.

Invoices must be an accurate representation of the service provided to the patient. If applicable, an invoice should indicate that a service was provided outside of the clinic (e.g., in a patient’s home). Otherwise, the receipt will infer that the service was provided in the clinic as the address of the clinic will be the only locale information.

Members must obtain informed consent before and throughout treatment.

The Health Care Consent Act, 1996 does not require practitioners to use written consent forms. Consent may be obtained in writing or verbally, or it may be implied. However, CTCMPAO strongly recommends written express consent in the form of a signed and documented Consent to Treatment form and/or documenting the informed consent in the patient record. Please note that unless the Consent to Treatment form sets out all of the elements of informed consent (e.g., discussing the proposed treatment, setting out the risks, providing an opportunity to ask any questions), it is not evidence of informed consent. It would only be evidence of general consent and not evidence that the member has informed consent to provide the treatment.

Members must always get expressed consent for treatment that involves contact with sensitive areas. For the initial treatment, the expressed consent must be written.

Consent is an ongoing process. Members re-confirm consent at each visit.

However, if there has been any change to the treatment plan or the patient’s health, a new informed consent is required. This is why it is prudent to verify with the patient at each appointment if they still provide consent to proceed and to check in on any changes to the patient’s health.

For more information on consent, please refer to the Standard for Consent and the FAQs from the Webinar on the Standard for Preventing Sexual Abuse.

To maintain accuracy and comprehensiveness of patient records, verbal consent ought to be noted by the practitioner in patient records immediately after treatment. The patient signature or initials are not required for verbal consent.

For more information on consent, please refer to the Standard for Consent.

Consent is an ongoing process. Members should re-confirm consent at each visit. If there has been any change to the treatment plan or the patient’s health, a new informed consent is required.

It is important to remember that a consent form may not be an informed consent form. In order for a consent form to indicate evidence of informed consent, all elements as set out in the Health Care Consent Act must be addressed.

For more information on consent, please refer to the Standard for Consent.

Practitioners are required by law to explain proposed treatments to their patients and to receive their patients’ informed consent for the proposed treatment. If the electronic consent to treatment form does not address all of the required elements as set out in the Health Care Consent Act, then it will not be considered an informed consent form.

Patients’ consent to treatment could be in the form of a signed document (handwritten signature or digital signature) or a notation by the practitioner in the patient record setting out what was discussed. The written consent reassures the practitioner and the patient that the patient has provided informed consent so that the practitioner can provide the treatment.

Please remember, consent is an ongoing process. Practitioners should re-confirm consent at each visit.

The services that may be provided using telepractice can include:

• Initial assessment and monitoring
• Home-based modalities
• Herbal medicine
• Dietary therapy and lifestyle advice

Certain assessments may be difficult to conduct over telepractice, such as tongue, pulse or palpation. For example, while a tongue examination may be possible, this would be dependent on the quality of the patient and practitioner’s camera/video.

TCM treatments that cannot be provided include (but is not limited to):

• Acupuncture
• Cupping
• Gua Sha
• Tui Na

Practitioners may sell herbs and herbal products online; however, practitioners must consider whether the products will require a TCM diagnosis and prescription or be available for over-the-counter purchase.

For herbs and herbal products that require prescriptions, TCM practitioners must take into account all precautions (e.g., dosage and toxicity) and contraindications (e.g., use of prescription medication, allergies, etc.) of the herbs and formulas recommended to the patient. This means the age, body weight, constitution, and condition of the patient must be considered before providing a prescription. The College’s Educational Tip on TCM Herbal Prescriptions provides additional information.

Any herbs that practitioners are selling to the public must be approved by the Natural and Non-prescription Health Products Directorate(NNHPD)

Regarding over-the-counter (OTC) products, it would be up to the practitioner to ensure that the necessary prescription information is available for the products they are selling. If that information is not available on the product, it would be up to the practitioner to ensure that the written information is provided to the customer. For more information, please refer to the Safety Program Handbook

A practitioner must be registered with CTCMPAO to practise the profession. If a practitioner is in a jurisdiction that also regulates TCM, the practitioner cannot practise from that jurisdiction without being registered.

Note that if a practitioner treats a patient in another jurisdiction, they are practising in both jurisdictions. This is why it is important for practitioners to be mindful of the regulatory requirements wherever they are practising and wherever their patients reside.

CTCMPAO members treating patients outside of Ontario must comply with the registration/licensing requirements in Ontario and the jurisdiction where the telepractice service will be provided and received (by the patient).

Practitioners must ensure they are following the regulatory requirements of the jurisdiction that the patient resides in. Practitioners will need to check if TCM and/or acupuncture is regulated in their specific location. If so? Then the practitioner will need to be regulated in the other jurisdiction.

A practitioner must be registered in Ontario to communicate a TCM diagnosis to a patient in Ontario.

As this would include providing care via telepractice, guest presenters must comply with the registration/licensing requirements in Ontario and the jurisdiction where the telepractice service will be provided.

Telepractice may provide opportunities for more informal types of interaction, which may lead to potential boundary crossings. For example, suppose a practitioner allows for text messaging with patients. In that case, they should carefully consider their expectations of how and when they will use and respond to text messages from their patients. Members will also want to remember and consider how these text messages are incorporated into the patient record.

Practitioners should also pay attention to the environment where telepractice will occur and avoid any personal items that may increase the risk for boundary crossings or violations.

Practitioners are always responsible for maintaining the boundary and keeping the relationship professional.

Members can refer to the Telepractice Guideline for more information.

It is recommended that practitioners discuss this with their patients at the outset, to ensure that professional boundaries are being maintained.

Practitioners and/or clinic owners may wish to have a policy that prohibits recording during in-person and telepractice appointments.

As a reminder, members are required to discourage patients from posting and/or leaving testimonials (i.e., comments, pictures and/or videos).

Practitioners should also pay attention to the environment where telepractice will occur and avoid any personal items that may increase the risk for boundary crossings or violations.

The College does not recommend this as the patient cannot consent to treatment in advance. In order for consent to be informed, it must comply with the Health Care Consent Act, 1996 (e.g., the patient has to be informed of nature of the treatment; the expected benefits of the treatment, the material risks of the treatment, the material side effects of the treatment, alternative courses of action, and the likely consequences of not having the treatment, and the patient has to have an opportunity to ask the practitioner any questions and have them answered). This dialogue can only occur after the practitioner and the patient has a dialogue about the proposed treatment.

If practitioners wish to send information to the patient in advance, they can do so. But until informed consent has been obtained, a signature on a form will not suffice.

Practitioners must maintain patient records in accordance with the Standard for Record Keeping. Patient records should indicate that a service was provided remotely as this is an accurate reflection of the nature of the appointment.

This would be up to the practitioner’s discretion and specific record keeping methods. This may include making a note in the record of the date/time of the text, phone call or email.

Telepractice can include various communication technologies, such as telephone, email and video conferencing. Note that all such technologies must ensure confidentiality of patient information.

The College cannot recommend specific record keeping or telepractice software. However, for records kept electronically, there must be backup files and restore protocols in place. Access to the computer records must be secured via password to avoid tampering.

The Office of the Information and Privacy Commissioner of Ontario has  information on safeguarding personal health information stored electronically.

There are currently four other provinces that regulate TCM Practitioners and/or Acupuncturists, including:

• College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia
• College of Chinese Medicine Practitioners and Acupuncturists of Newfoundland and Labrador
• College of Acupuncturists of Alberta
• Ordre des acupuncteurs du Québec