What is a Patient Request form?
A Patient Request form is a PHIPA-compliant form that requires hospitals to release the identified patient’s health information within 30 days of receiving the request.
When is a Patient Request form used?
Individuals use this form when they are looking to request their own information from a hospital, clinic, or lab site they have visited in the past. All registered health facilities are required by law to respond to these requests.
What are the details included on a Patient request form?
A patient request form includes the following information for the requesting patient:
- Full name
- Date of birth
- Canadian provincial health insurance plan number
- Residential address
- Email address
- Phone number
- Electronic, legally binding signature
- Delivery method instructions
This form also includes details on the hospital or other health institution the patient is requesting information from:
- Name of the health institution
- Business address
What is Dot Health?
Dot Health is a secure, online personal health data platform that allows individuals to request their own personal health information and keep it up-to-date.