Get Health Information Access Request Health Information Management

This guide provides clear and supportive instructions for users on how to complete the Health Information Access Request form effectively. Whether you are requesting your own health information or on behalf of someone else, follow these steps to ensure a smooth submission process.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access and open the Health Information Access Request form online.
2. Begin with the 'Patient/Client Information' section. Enter the last name, first name, birthdate (in the format yyyy-Mon-dd), and personal health number of the patient for whom you are requesting information.
3. Complete the 'Requester Information' section. Print your last name and first name. Fill in your complete mailing address, city/town, province, and postal code. Provide a phone number where you can be reached during business hours.
4. In the 'Information Requested' section, specify the name and location of the facility providing the health services. Clearly indicate the records or information you want and specify the time period of the records. You can attach a separate sheet if more space is needed.
5. Indicate how you would like to receive the information by checking the appropriate box — either to have it mailed to the address you provided or to pick it up in person (ID is required for pickup).
6. In the 'Authorization' section, check the applicable box that describes your authority to request information on behalf of a patient/client, and attach proof of authorization where necessary.
7. Sign and date your request at the bottom of the form, using the format yyyy-Mon-dd.
8. Review your completed form for accuracy and clarity. Save any changes, download a copy for your records, and print the form if necessary.
9. Submit your request by delivering it in person, mailing, or faxing it to Health Information Management at the location where you received health services.

Complete your Health Information Access Request online now to efficiently retrieve your health information.