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Requesting Your Health Record

​​​​​You have the right to request access (a copy or to view) to the personal health information contained in your health record or the health record of a patient for whom you are the Substitute Decision Maker (SDM), for incapable patients.  

To request copies of or to view your health record, an Authorization for Release of Personal Health Information form will need to be completed in full by the patient or, for incapable patients, the Substitute Decision Maker. The completed form will then need to be submitted to our office via mail/drop off.

To avoid request delays, please ensure the form is completed in full, signed, dated and witnessed.  If you are requesting information as the authorized Substitute Decision Maker for a patient who is incapable, you will need to verify your role by providing the necessary documentation (e.g. copy of Power of Attorney for Personal Care document).

For further completion guidelines, please read page 2 of the Authorization for Release of Personal Health Information form.

​Response time

We will respond to requests for personal information as soon as possible, and no later than 30 days after receiving a request.  If we are unable to respond to the request within 30 days, the we will notify the requestor in writing, setting out the length of the extension and the reason for the extension.



​To open the 
Authorization for Release of Personal Health
Inform​​ation ​
f​orm, click here. See above for more details.


Please contact our Health Records Department if you require assistance with this process or if you have questions regarding:
  • Privacy policies,
  • How to access your personal health information,
  • How to request a correction of personal health information, or
  • To identify a privacy issue.
Health Records Department
712 Richmond Street, Box 306
Chatham, Ontario  N7M 5K4
Ph: 1-888-447-4468 ext. 7345 or 5333
Fax: 519-436-2430