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GUIDE TO LEGAL REPORTING REQUIREMENTS

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The law requires physicians to report certain events and clinical conditions either to the College of Physicians and Surgeons of Ontario (“CPSO”) or other health regulatory bodies (i.e., colleges) and agencies. While not exhaustive, this document provides an overview of some of the key laws and is meant to assist physicians in navigating their legal reporting duties.

Refer to the legislation directly and contact the Canadian Medical Protective Association for advice about your specific reporting requirements. In case of any inconsistency between this document and applicable legislation, the legislation will always prevail.

Listed below are the legal reporting requirements captured in this document:

Reports to CPSO and Other Health Regulatory Colleges

  • Facility Operators
    Physicians who operate a facility and have reasonable grounds to believe that a regulated health professional practising in the facility is incompetent or incapacitated must file a written report with the appropriate college within 30 days, or immediately if patients are likely to be harmed or injured.

    See sections 85.2 and 85.3(1) and (2) Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991. 

    Employers and Affiliates
    Physicians who employ, offer privileges to, or associate with regulated health professionals must file a written report with the appropriate college within 30 days when, for reasons of professional misconduct, incompetence or incapacity:
    • the physician takes disciplinary action against (e.g., terminates employment, restricts privileges) or ends a business association with (e.g., dissolves a partnership) a regulated health professional
    • a regulated health professional voluntarily gives up their employment or privileges. 
    See section 85.5 Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991. 

    Public Hospitals 
    Physicians who are hospital administrators must file a report with CPSO when, for reasons of incompetence, negligence, or misconduct:
    • a physician’s application to work in a hospital is rejected, or their employment or privileges are restricted or cancelled
    • a physician resigns or limits their practice in a hospital.
    See section 33 Public Hospitals Act.

  • Physicians who employ, offer privileges to, or are otherwise affiliated with regulated health professionals must file a written report with the appropriate college within 30 days when, as a result of a privacy breach:

    • they take disciplinary action against (e.g., terminate employment, restrict privileges) or end an affiliation with a regulated health professional
    • a regulated health professional voluntarily gives up their employment, privileges or affiliation.

    See sections 17.1(2) and (5) Personal Health Information Protection Act, 2004 (PHIPA).

  • Physicians must file a written report with CPSO as soon as possible regarding:

    • charges and/or findings of guilt for the following offences, as well as any related conditions of release or restrictions:
      • offences under the Criminal Code, the Controlled Drugs and Substances Act, the Food and Drugs Act, the Health Insurance Act and/or under comparable legislation in any province or jurisdiction, and
      •  any other offences related to the practice of medicine.
    • findings of professional negligence or malpractice
    • findings of professional misconduct or incompetence by a professional regulatory body in any jurisdiction.

    Physicians must also file a report if there is a change in any of the above.

    See sections 85.6.1 to 85.6.4 Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991.

  • Physicians who have reasonable grounds to believe that another regulated health professional may have sexually abused a patient must:

    • file a written report with the appropriate college within 30 days, or immediately if they have reasonable grounds to believe the sexual abuse will continue or other patients will be sexually abused
    • make best efforts to tell the patient before submitting a report.

    Physicians providing psychotherapy to the subject regulated health professional have additional reporting requirements, including providing an opinion, if possible, about the likelihood of the regulated health professional sexually abusing patients in the future.

    See sections 1(3), 85.1, 85.2(1) and 85.3(1), (2), (4) and (5) Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991.

Reports to Other Agencies

  • Physicians who have reasonable grounds to suspect that a child younger than 16 years old has experienced or is at risk of experiencing abuse or neglect must:

    • immediately and directly report to a Children’s Aid Society (CAS)
    • not rely on anyone else to report on their behalf
    • file a further report if there are additional grounds to believe the child is experiencing or is at risk of experiencing abuse or neglect.

    Physicians who have concerns about a child who is 16 or 17 years old are permitted, but not required, to make a report to the CAS.

    See sections 125(1) to (4) Child, Youth and Family Services Act, 2017.

  • Live Births

    Physicians who are present when a baby is born must give notice of the birth to the Registrar General within two business days.

    See section 8 Vital Statistics Act (VSA) and section 1 General Regulation, enacted under the VSA.

    Still-Births

    Physicians who are present at a still-birth must:

    • give notice of the still-birth to the Registrar General within two business days
    • complete and deliver a medical certificate of still-birth to the funeral director.

    In certain circumstances, coroners must complete the medical certificate of still-birth.

    See section 9.1 Vital Statistics Act (VSA) and sections 19 and 20(1) General Regulation, enacted under the VSA.

    Deaths

    Unless there is reason to notify the coroner, physicians who are either present during or have enough knowledge of the illness that led to a person’s death must immediately:

    • complete and sign a medical certificate of death
    • deliver the medical certificate of death to the funeral director.

    See sections 21(1), (2) and (5) Vital Statistics Act (VSA) and sections 35(2) and 70 General Regulation, enacted under the VSA.

    Notification of Coroner

    Physicians who have reason to believe a person died under circumstances that may require investigation, including in an unnatural or unexpected way (e.g., due to violence or an accident), must immediately notify a coroner or police officer.

    See section 10(1) Coroners Act.

  • Physicians who are health information custodians (custodians) must report certain privacy breaches to the IPC at the first reasonable opportunity. This includes but is not limited to when:

    • personal health information is stolen, or used or disclosed without authority
    • the privacy breach is part of a pattern of similar breaches
    • the privacy breach is significant.

    Custodians must also:

    • notify the individual(s) whose privacy has been breached at the first reasonable opportunity
    • submit statistics to the IPC on or before March 1 each year setting out the number of privacy breaches that occurred.

    See sections 3, 12(2) and (3), and 55.5(7) Personal Health Information Protection Act, 2004 (PHIPA) and sections 6.3, 6.4, and 18.3 General Regulation, enacted under PHIPA.

  • Physicians who conduct medical examinations on workers who work with designated substances or in a compressed air environment must promptly file a report with the Provincial Physician of the Ministry of Labour, Immigration, Training and Skills Development if they determine a worker is: (1) fit to work with limitations, or (2) not fit to continue working.

    See sections 29(1), (2) and (7) Designated Substances Regulation, enacted under the Occupational Health and Safety Act (OHSA), and sections 352(9) and (11) Construction Projects Regulation, enacted under the OHSA.

  • Physicians who know that a controlled substance was lost or stolen from their office must submit a written report to Health Canada’s Office of Controlled Substances within 10 days.

    See sections 61(2) and 72(2) Benzodiazepines and Other Targeted Substances Regulations enacted under Controlled Drugs and Substances Act (CDSA), section 55(g) Narcotic Control Regulations enacted under CDSA; and section G.04.002A(g) Food and Drug Regulations enacted under Food and Drugs Act.

  • Communicable Diseases and Diseases of Public Health Significance

    Physicians must file a report with the medical officer of health of the local health unit as soon as possible when:

    • the physician signs a death certificate indicating that a disease of public health significance caused or contributed to a patient’s death
    • a person who is not a patient at a hospital has or may have a disease of public health significance
    • a person who is under the physician’s care has or may have a designated communicable disease.

    Physicians must also file a report when a person who is under their care for a designated communicable disease does not follow recommended treatment.

    See sections 25(1), 26, 30 and 34(1) and (2) Health Protection and Promotion Act (HPPA).

    Eyes of Newborns

    Physicians who are present when a baby is born and know the baby’s eye(s) are red, inflamed or swollen must file a written report with the medical officer of health within two weeks.

    See section 33(1) Health Protection and Promotion Act, (HPPA) and section 1 Communicable Diseases – General Regulation, enacted under the HPPA.

    Rabies

    Physicians must file a report with the medical officer of health as soon as possible when they know a person:

    • was bitten by a mammal
    • had contact with a mammal that could result in the person getting rabies.

    See section 2(1) Communicable Diseases – General Regulation, enacted under the Health Protection and Promotion Act.

    Reactions to Vaccines

    Physicians must file a report with the medical officer of health of the local health unit within seven days if they believe a patient who received a vaccine subsequently experienced a particular reaction to the vaccine, including but not limited to:

    • persistent crying or screaming, or anaphylaxis or anaphylactic shock within 48 hours
    • collapsing, a high fever or a seizure within three days
    • arthritis within 42 days
    • death following a symptom above.

    See sections 38(1) and (3) Health Protection and Promotion Act.

  • Physicians must immediately report to the Director of the Ministry of Long-Term Care (in the case of long-term care homes) or the Registrar of the Retirement Homes Regulatory Authority (in the case of retirement homes) when they suspect:

    • a resident may have experienced or may experience harm as a result of improper or incompetent care, unlawful conduct, abuse or neglect
    • a resident’s money may have been misused or misappropriated.

    Physicians who suspect funding for a long-term care home may have been misused or misappropriated must also immediately report to the Director of the Ministry of Long-Term Care.

    See sections 2(1), 28(1) and (4) Fixing Long-Term Care Act, 2021 and sections 75(1) and (3) Retirement Homes Act, 2010.

  • Physicians must promptly file a report with the General Manager of the Ontario Health Insurance Plan if they have reason to believe that a person:

    • received preferred access to an insured medical service in exchange for money or another benefit
    • accepted payment or another benefit to provide patients preferred access to an insured medical service.

    See sections 17(1) and (2) Commitment to the Future of Medicare Act, 2004, (CFMA) and section 7(1) General Regulation, enacted under the CFMA.

  • Physicians who know health card fraud has been committed must promptly report to the General Manager (GM) of the Ontario Health Insurance Plan (OHIP). This includes when a person who is not insured under OHIP:

    • receives or tries to receive an insured service
    • receives or tries to receive payment for money they spent on an insured service
    • gives false information about their residency to the GM or OHIP.

    Physicians are permitted, but not required, to report any concerns that relate to the administration of the Health Insurance Act.

    See section 43.1 Health Insurance Act (HIA) and section 1(1) Health Fraud Regulation, enacted under the HIA.

  • Physicians involved in the care of mentally ill patients following community treatment orders and who issue an order for examination must provide the police with:

    • up-to-date contact information of the physician responsible for completing the examination required under the order
    • immediate notice if the patient voluntarily goes to the examination or if the order is cancelled for any other reason before it expires.

    See section 7.4 General Regulation, enacted under Mental Health Act.

  • Physicians who treat inmates in a correctional facility must file a report with the Superintendent:

    • immediately when an inmate is seriously ill
    • in writing when an inmate is injured
    • immediately and in writing when the physician determines an inmate is unfit to work or that their work should be changed.

    Physicians who treat inmates in a correctional facility must immediately file a report with the medical officer of health of the local health unit when an inmate has or may have a designated communicable disease.

    See sections 4(3) to (5), General Regulation, enacted under the Ministry of Correctional Services Act, and section 37(1) Health Protection and Promotion Act (HPPA).

  • Impaired Driving Ability

    Physicians who treat a patient who is at least 16 years old must report to the Registrar of Motor Vehicles if the patient is diagnosed with a medical condition that can impair the ability to drive despite treatment.

    Physicians are not required to report:

    • impairments that are temporary or unlikely to recur (e.g., a broken ankle, recovering from anesthesia after surgery)
    • small or gradual changes in a patient’s ability due to aging (unless they amount to a medical condition that can impair the ability to drive despite treatment).

    Physicians who have reasonable grounds to believe that a patient has other medical conditions and issues that may make it dangerous to drive are permitted, but not required, to make a report.

    See sections 203(1) to (4) Highway Traffic Act (HTA) and section 14.1 Drivers’ Licences Regulation, enacted under the HTA.

    Pilots or Air Traffic Controllers

    Physicians who have reasonable grounds to believe that a patient working as a flight crew member, air traffic controller, or in another aviation job that requires standards of medical fitness, may have a medical condition that might pose a danger to aviation safety, must report to a medical advisor designated by the Minister of Transport immediately.

    See section 6.5(1) Aeronautics Act.

    Maritime Safety

    Physicians who have reasonable grounds to believe that a patient with a certificate issued under the Canada Shipping Act, 2001 may have a medical condition that might pose a danger to maritime safety must report to the Minister of Transport without delay.

    See section 90(1) Canada Shipping Act, 2001.

    Railway Safety

    Physicians who have reasonable grounds to believe that a patient working in a job related to railway safety may have a medical condition that might pose a danger to safe railway operations must report to a physician specified by the relevant railway company without delay.

    Physicians must also:

    • take reasonable steps to inform the patient before making the report
    • send the patient a copy of the report without delay.

    See section 35(2) Railway Safety Act.

Endnotes

  1. Sexual abuse includes behaviour or remarks of a sexual nature. 

  2. This reporting requirement only applies when this information is obtained in the course of practising the profession. 

  3. The person who has direct supervision and control of a hospital (s. 1 Public Hospitals Act).

  4. This reporting requirement applies only to physicians who are health information custodians (custodians). See s. 3 of PHIPA for more information on custodians. Agents of custodians have separate reporting requirements under s. 17(4)(b) PHIPA.

  5. This includes the unauthorized collection, use, disclosure, retention, or disposal of personal health information by the employee.

  6. Abuse includes but is not limited to physical harm, sexual abuse or exploitation, and emotional harm.

  7. A list of CAS offices can be found on the Ontario Association of Children’s Aid Societies’ website.

  8. See the Government of Ontario’s website for more information on how to make a report, including how to complete and access the Medical Condition Report Form. Physicians may also consider the CCMTA Medical Standards for Drivers published by the Canadian Council of Motor Transport Administrators and the Driver’s Guide: Determining Medical Fitness to Operate Motor Vehicles published by the Canadian Medical Association when determining whether a person has or appears to have a prescribed condition.

  9. The prescribed conditions are outlined in s. 14.1(3) of the Drivers’ Licences Regulation enacted under the Highway Traffic Act. See CPSO’s Advice to the Profession: Reporting Requirements for guidance on reporting to the Ministry of Transportation. 

  10. See the Transport Canada website for information on reporting concerns related to aircraft safety.

  11. See the Transport Canada website for contact information.

  12. Notices of live birth may be completed by paper and submitted by mail, or completed and submitted online. See the Government of Ontario’s website for contact information for the Registrar General.

  13. There is no online process for still-birth registration. See the Government of Ontario’s website for contact information for the Registrar General.

  14. See the Government of Ontario’s Handbook on Medical Certification of Death & Stillbirth for more information on how to complete a medical certificate of still-birth.

  15. For guidance on reporting deaths resulting from medical assistance in dying (MAID) and completing medical certificates of death in the MAID context, see CPSO’s Legal Requirements: MAID and Advice to the Profession: MAID.

  16. Coroners and physicians providing palliative care outside a hospital setting (e.g., a patient’s residence, hospice, long-term care home) can complete and submit a medical certificate of death electronically. See the Government of Ontario’s Handbook on Medical Certification of Death & Stillbirth and CPSO’s Advice to the Profession: End-of-Life Care for more information on medical certificates of death.

  17. For situations where there is no funeral director involved, see the Government of Ontario’s website.

  18. Reports can be submitted via the privacy breach reporting form. For more information, see the IPC’s Reporting a Privacy Breach to the IPC: Guidelines for the Health Sector.

  19. See IPC’s Report a Privacy Breach or s. 6.3(1) of the General Regulation enacted under PHIPA for information on what constitutes a “significant breach”. 

  20. Reports can be submitted using the IPC’s Online Statistics Submission website. For more information, see the IPC’s Annual Reporting of Privacy Breach Statistics to the Commissioner.

  21. See s. 2 Designated Substances Regulation enacted under the OHSA for the list of designated substances. 

  22. See the Government of Ontario’s website for the Provincial Physician’s contact information. 

  23. Schedules I, II, III, IV and V of the CDSA outline the items that constitute a “controlled substance,” which include a targeted substance, narcotic, or controlled drug.

  24. See Health Canada’s website to access the Loss or Theft Reporting Form and E-Services Portal.

  25. See the Ministry of Health’s website for a list of public health units.

  26. See the Designation of Diseases Regulation, enacted under the HPPA for a list of diseases of public health significance and designated communicable diseases.

  27. A hospital administrator’s reporting duty arises if the hospital record states that a patient or an out-patient of the hospital has or may have a disease of public health significance or a designated communicable disease (s. 27(1) HPPA).

  28. See the Designation of Diseases Regulation, enacted under the HPPA for the list of designated communicable diseases.

  29. See the Ministry of Health’s website for a list of public health units.

  30. See the Government of Ontario’s website for information on filing a report.

  31. See the Retirement Homes Regulatory Authority website for information on filing a report.

  32. While reporting misused or misappropriated funding is only required in the context of long-term care homes, the Retirement Homes Regulatory Authority also encourages physicians to make reports on such issues.

  33. See the Government of Ontario’s website for contact information for the Health Insurance Branch of the Health Programs and Delivery Division.

  34. See the Ministry of Health’s website for more information on OHIP fraud. See also the Government of Ontario’s website for contact information for the Health Insurance Branch of the Health Programs and Delivery Division.

  35. See the Government of Ontario website for contact information for correctional and detention centres.

  36. See the Ministry of Health’s website for a list of public health units.

  37. See the Designation of Diseases Regulation, enacted under the HPPA for the list of designated communicable diseases.