The Privacy Act also affords the client the right to challenge theaccuracy and completeness of his or her personal information and have it amended as appropriate. The Privacy Act provides the client with a right toaccess his or her own personal information which is under the control of the Department. Any personal information recorded on this form is accessible by the individual to whom it relates.Īll personal information collected and used is protected from unauthorized disclosure by the Privacy Act. Provision of the information is on a voluntary basis. The client's personal information is collected under the authority of the Veterans Health Care Regulations for the purpose of administering benefits andservices. Address and postal code Date of birth (yyyy-mm-dd) Date of assessment (yyyy-mm-dd)Ĭe formulaire est disponible en français. The client may request a copy of this form by writing to the Access to Information and Privacy Coordinator's Office, Veterans Affairs Canada, PO Box 7700, Charlottetown, PE, C1A 8M9 and by quoting Personal Information Bank No. The Privacy Act also affords the client the right to challenge the accuracy and completeness of his or her personal information and have it amended as appropriate. The Privacy Act provides the client with a right to access his or her own personal information which is under the control of the Department. A ll personal information collected and used is protected from unauthorized disclosure by the Privacy Act. Any personal information recorded on this form is accessible by the individual to whom it relates. The client's personal information is collected under the authority of the Veterans Health Care Regulations for the purpose of administering benefits and services. Designation Montreal Cognitive Assessment (MOCA) VAC 762e (2010-06) Signature Date (yyyy-mm-dd) Ce formulaire est disponible en français.
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