Request for Access to Personal
Health Information


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

To make a request for access to personal health information, a completed Request for Access to Personal Health Information form needs to be submitted by mail or fax to the North Simcoe Muskoka (NSM) CCAC Health Records Department.  To avoid delays, check that all information is completed on the form and that it is dated and signed.  If you are the SDM of an incapable patient, provide the necessary document to support that you are the SDM (copy of Power of Attorney for Personal Care document for example).

When detailing the personal health information you are requesting to access, specify if you are requesting a specific document, documents within a time period, documents pertaining to an encounter, or the entire record.  It is advised to include dates and timeframes wherever possible.

Preparation fee


There is a preparation fee to receive a copy of personal health information.  The preparation fee varies with the size of the release.  The invoice will be sent to you with the information requested.  The preparation fee is:

  • $30.00 for the first 20 pages and $0.25 per page thereafter, or
  • $25.00 for a letter (example: confirmation of service).

The preparation fee applies to the patient (or their SDM), or to a law firm, legal aid clinic, advocacy centre, insurance company or employer requesting information with patient/SDM consent.

Alternatively, the record(s) can be viewed at one of the NSM CCAC offices at no cost.


Response time

Records will be sent to you by courier within 30 days from the date we receive the fully completed form.  If your request is urgent, please provide rationale on the request form including the date the records are required.  NSM CCAC will contact you if we cannot meet your request timeline.


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To open the Request for Access to Personal Health Information form, click here.  To make a request for personal health information, this form must be submitted by mail or fax to the NSM CCAC Health Records Department.


Contact Us

Please contact the NSM CCAC Health Records Department if you require assistance with this process or if you have questions regarding:

  • NSM CCAC privacy policies,
  • How to access to your personal health information,
  • How to request a correction of personal health information, or
  • To identify a privacy issue.


705-721-8010 Ext. 6641 or
1-888-721-2222 Ext. 6641  

Fax: 705-792-6299

Health Records Department
15 Sperling Drive, Suite 100,
Barrie, ON L4M 6K9