Reviewing or Obtaining your Health Record

Reviewing Or Obtaining Your Health Record

Patients are entitled to access their health information. Mental health requests may be subject to approval by the health care provider.

All requests must be made in writing by completing a Consent to Disclose, Transmit, Access or Examine Personal Health Information Form and include:

Original Signature of patient or Substitute Decision Maker (SDM)
Date of authorization
(this must be within 90 days of the request.)
Witness
(the signature of a person verifying that the patient or the SDM did in fact sign the authorization.)
Name of recipient
(the person or company to whom the information may be disclosed)
Purpose of Request
(ex. further treatment, legal request, family records)
Treatment date
(if the exact date is unknown please provide an approximate range)

Health Information Management is unable to review or advise upon personal health records. We recommend that health information be reviewed in conjunction with your health care provider, so that interpretation may be provided if necessary.

Fees

There is no fee for information given to health care providers

Patients	$30 for 1-20 pages of medical information. $0.25/page thereafter Copy of the visit history – no charge.
Lawyers	Prepayment of $30 for 1-20 pages $0.25/page thereafter
Insurance	Prepayment of $160 for 1-20 pages $0.25/page thereafter
Letters	$30 (ex. Confirmation of Attendance, Birth Letters and non-medical birth information i.e. time of birth)
Rush (<48 hours)	$300 plus regular fees

Records are processed according to medical priority sequencing, and will be completed in a timely fashion.

Completed requests can be mailed to:
Credit Valley Hospital
2200 Eglinton Avenue West
Mississauga, Ontario, L5M 2N1
ATTENTION: Health Information Management, Release of Information

Phone: 905-813-4325
Fax: 905-813-4101

Health Information Management