Release Authorization

Your Health Record is highly confidential and we release copies only on your authorization. We can pre-authorize release of medical records to family physicians once a signed authorization to advise the family doctor is listed in the patient record. In any other circumstance, we require a separate written document. Requests for Health Records, other than Mental Health Records, require a written authorization detailing:

Patient Information:  Name, Date of Birth, Health Card Number, Address, Phone Number.

Doctor Information:  Name, Address, Phone Number, Fax Number.

Records:  Exact specification of which records are required.

Signature:  Original signature of the patient (16 years of age or older and competent).

Date:  The date the authorization is signed. The date must be within 90 days.

We require a Ministry of Health FORM 14 for any release of Mental Health Records to parties other than the patient. If the patient requests Mental Health Records, we require a FORM 28. The release of Mental Health Records must be approved by the patient's psychiatrist. For a copy of a FORM 14 or FORM 28, click here.