Get Request To Access Health Information Form - Alberta Health And ...

This guide provides clear instructions for completing the Request To Access Health Information Form. By following these steps, users can effectively request their health information securely and efficiently.

Follow the steps to fill out your request form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'About you' section, select your preferred title and enter your last name and first name. Complete your mailing address along with your telephone numbers for both business and home. Include any fax number or email address if available.
3. Attach the initial fee of $25.00 for processing your request.
4. In the 'About your request' section, specify the custodian's name from whom you are requesting your health records.
5. Choose whether you would like to receive a copy of the record or just examine it by selecting the appropriate option.
6. In the 'About the information you want to access' section, provide detailed information on the records you are requesting. Include any previous names and identifying numbers like your personal health number.
7. State the specific time period for the records you wish to access. Clearly mention the dates in the format requested.
8. Sign and date the form to validate your request. Ensure that the completed form is sent to the appropriate HIA Coordinator or the person responsible for processing these requests.
9. Finally, save any changes made, and choose to download, print, or share the filled-out form as needed.

Take action now and fill out your Request To Access Health Information Form online.