Medical Records

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For your convenience, please find specific forms below to support your access to medical information or identifying others who you authorize to receive your medical information or updates.

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Please complete the appropriate form. A reasonable administrative fee may apply for the preparation, copying, printing, or transfer of medical records. If a fee applies, you will be notified of the cost before your request is processed. Fees are determined in accordance with Ontario privacy legislation and applicable guidelines.

 

If you are transferring your care to another healthcare provider, please complete the authorization form identifying the receiving provider.

 

In accordance with the “Personal Health Information Protection Act” PHIPA, the Clinic has up to 30 days to process a request once we have received a request with a valid consent and a prepayment fee (where applicable). If the request cannot be completed within 30 days, we will contact you to explain the reason for delay.

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1. Authorization for Disclosure of Personal Health Information

2. Request for Medical Records

3. Transfer of Medical Information to a New Provider

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