Patient Access forms

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:

  1. Full name
  2. Date of birth
  3. Canadian provincial health insurance plan number
  4. Residential address
  5. Email address
  6. Phone number
  7. Electronic, legally binding signature
  8. Delivery method instructions

This form also includes details on the hospital or other health institution the patient is requesting information from:

  1. Name of the health institution
  2. 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.