Health Records

Health Information Management department (Health Records) is located on Wing C, Level 0. Your personal health information is secured, checked for accuracy, completeness and retained for the legal retention period according the Public Hospital Act and the Personal Health Information Protection Act.

We share your personal health information with your health care providers. If you do not want us to share your information, please let us know.

For circle of care requests during Release of Information operating hours; 9:00am to 4:30pm Monday to Friday (excluding Stat holidays) please submit request by:

Fax: Completed 1^st in order of Fax received – Release of Information Fax# 519-740-4958
Email: Completed within 24-48hrs of Email received – Release of Information Email ReleaseofInfo@cmh.org
Phone: Completed within 24-48hrs of Phone call received – 519-621-2333 ext. 1382 (please note due to the high volume of calls and requests, you may have to leave a voice message. Please include patient name, date of birth or health card number, name of office or healthcare provider and phone and fax numbers.)

If you require a request form, one can be found here - Circle of Care Request Form

Any circle of care request outside of Release of Information operating hours should be faxed to: 519-740-4921

**please note at this time Health Records cannot be provided via email**

Under Ontario’s Personal Health Information Protection Act (PHIPA), you have a right of access to your own personal health information. Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A (ontario.ca)

Health information is retained for the period required by law. If you were an adult (18 years according to the legislation) at the time of treatment, the information is retained ten (10) years past the date of treatment. In the case of a child under the age of 18 years, the information will be retained for a period of twenty-eight (28) years. Radiology films are retained for five years. Records beyond this retention period are destroyed.

If you would like to see a copy of the form that you'll need to fill out to access your Personal Health Information or the information of someone for whom you are the legal Substitute Decision Maker (SDM) you may see the sample form here. (This copy of the form cannot be filled out.)

When you are confident that you're ready to start the process to access your Personal Health Information (Medical reports/records, Health records/reports) you, or your Substitute Decision Maker (SDM - a person who can make decisions on your behalf), may complete the following form:

• Request and Authorization Form
  • - You will have to provide a copy (an electronic copy such as a scan or digital photo) of government issued photo ID along with the completed form
    • Government issued Identification – i.e. Driver’s License, Health Card, Passport

• If you're the SDM/Executor - See the section of the form regarding SDM/Executor for required information. (Request and Authorization Form for PHI)
  • You will have to provide a copy of government issued photo ID along with the completed form along with proof of SDM or executorship in addition to your government issued photo ID.
    • Government issued Identification – i.e. Driver’s License, Health Card, Passport

When you submit the signed form with the required documentation, you will receive an email notification as soon as the request has been viewed. You will receive another email notification when your request has been completed, the completed form will contain the earliest date the records can be released/picked up from the Release of Information office.

**Requests will not be processed without a completed Request and Authorization form, and verification of ID. Requests are processed in order of receipt. Please note, requests will take approximately 3-15 business days to be processed, although we have up to 30 days to complete as per IPC and PHIPA. A processing fee may apply, as per our current fee schedule. Fee Schedule**

Custodial parents of children under 16 years of age can request records on their child’s behalf; please note that consent from both parents may be required.

If you cannot complete the online Request and Authorization form to access your health information (medical records) you, or your substitute decision maker, may contact the Release of Information Office via Phone/Email/Fax/Mail and request a copy/access to your health information. Please do not come to the office unless the request has already been submitted and you have been informed that your records are available to pick up. Due to the volume of phone calls it may take 24-48 hours to respond to any voice message. Please include the following information with your voice/email/fax/mail message: name, date of birth, phone number and brief details of records request. If you require your records to be sent directly to a health care provider, this can be done free of charge within a 24-48hrs time period. Along with the previous information please include Healthcare provider information and details of records to be sent.

Release of Information Contact Information:

Email: ReleaseofInfo@cmh.org

Fax# 519-740-4958

Mail: Release of Information
700 Coronation Blvd.
Cambridge, ON N1R 3G2

Phone#519-621-2333 ext. 1382 (leave a message)

You will be notified when records are available to pick up.

We can also accept payment by credit card over the phone to send records through Canada post.

Please note:

• Please keep in mind there may be a 24-48 hour wait for a response from Release of Information.
• Records CANNOT be provided via email at this time.
• Records will not be prepared during admission, 72-96 hours after the discharge at a minimum will be required. (IPC standards- allows 30 days to complete requests)
• The requests will not be completed "on demand”. Requests are completed in order of receipt, those with the completed Request and Authorization form will be given priority.
• Release of Information staff are not authorized to provide test results, including lab or imaging.
• There may be a fee for requested records. $30.00 for pages 1-20 + $0.25\page thereafter
• Imaging on CD $10.00/CD
• Please direct insurance forms to your family doctor to complete
• Looking for a family doctor – www.doctors4cambridge.com
• Records will not be prepared during admission. 72-96 hours after the discharge at a minimum will be required. (IPC standards- allows 30 days to complete requests)
• The requests will not be completed "on demand”. Requests are completed in order of receipt. Those with the completed Request and Authorization form will be given priority.
• Release of Information staff are not authorized to provide test results, including lab or imaging.

Phone# 519-621-2333 Ext. 1382
Fax# 519-740-4958
Email: ReleaseofInfo@cmh.org

Our hours of operation are 9:00am to 4:30pm Monday to Friday (Excluding all Statutory Holidays)

Office location Wing C, Level 0, Room# 228

If you require a “Proof of” letter, please provide the following information to Release of Information:

• Proof of Birth Letter for Service Canada (IF NOT PROVIDED BY PHYSICIAN/MIDWIFE/BIRTHING UNIT)
  Mothers full name and Date of Birth
  Fathers full name
  Child’s full name and Date of Birth
  Current address
• Proof of Birth (School, Athletic Application, etc.)
  Mothers full name and Date of Birth Child’s full name and Date of Birth
  Current Address
• Proof of Death Letter
  Patient full name and Date of Birth
• Proof of Admission/Attendance
  Patient full name and date of birth Date range required (can be approx.)

Release of Information Contact Information:
Email: ReleaseofInfo@cmh.org
Fax# 519-740-4958
Mail:Release of Information
700 Coronation Blvd.
Cambridge, ON N1R 3G2

Phone#519-621-2333 ext. 1382 (leave a message)

You will be notified when records are available to pick up.

We can also accept payment by credit card over the phone to send records through Canada post.

Please note:

• There is a flat fee of $30.00 for “Proof of” Letters, see Fee Schedule.

There is an administrative fee for copies of your record based on the current fee schedule. An administrative fee of $30.00 shall apply to all requestors. This includes pages 1 to 20. After the first 20 pages, any additional pages will cost $0.25 cents per page. Your health record may be provided to you on a USB for an additional $10.00 (upon request).

Please note: There is no fee to release patient information to other health care facilities or physicians, for continuity of patient care.

PocketHealth allows you to share records online with any physician in full diagnostic quality with strong privacy and encryption protocols. For instructions on how to enroll in Pocket Health please see Pocket Health Info.

In department request – Go to Diagnostic Imaging Monday to Friday 8am – 5pm to request imaging on CD.

Deceased Patients - To release personal health information of a deceased patient, a signed CMH authorization form is required from the executor(s) of the estate (with proof, copy of first page where it names the executor(s) and last page where the patient/deceased signed the Will). If no Will exists, a Certificate of Appointment of Estate Trustee or an Administrator of Estate letter is required. Please contact Release of Information for more information on these items.

POA (Power of Attorney) – To release health information to the POA for personal care, a signed CMH authorization form is required along with the POA document.

SDM (Substitute Decision Maker) – To release health information to the SDM, a signed CMH authorization form is required along with proof of SDM.

More information about Substitute Decision Makers & Powers of Attorney for Personal Care and the Hierarchy of Substitute Decision Makers (SDMs) based on the Health Care Consent Act s.20.

The hospital does not issue birth certificates or keep the birth registrations on file. To obtain a birth certificate, contact Service Ontario at 1 800 461 2156 or through the Service Ontario website.

The hospital does not issue/copy death certificates. To obtain a death certificate, contact Service Ontario at 1 800 461 2156 or through the Service Ontario website.

A completed request form, including patient consent, can be emailed to: releaseofinfo@cmh.org

Records Request Form - Police

Please note:

• Records CANNOT be provided via email at this time.

If you want to update or correct your name, address, phone number, family doctor or other contact information, please inform registration the next time you check in or contact Release of Information:

Email: ReleaseofInfo@cmh.org
Fax# 519-740-4958
Phone# 519-621-2333 ext. 1382

Contact Privacy Office: Patient Privacy | Cambridge Memorial Hospital (cmh.org)
FOI information: Freedom of Information (FIPPA) | Cambridge Memorial Hospital (cmh.org)
Send request to: FOI@cmh.org

Request to Lock Personal Health Information (Lock-box)
Request to Unlock Personal Health Information (Lock-box)
Withdraw or Withhold Consent for Collection, Use or Disclosure of Personal Health Information

CMH does not remove health records in their entirety, but rather, does allow patients to request corrections to be made. In order to make a correction to your record, please fill out the Request to Correct Personal Health Information form clearly outlining what you are requesting to have changed. The form can be mailed in, emailed, or faxed. Once received, the HIM (Health Information Management) manager will notify the health care provider of your request. HIM has a period of 30 days to respond to your request at which time you will be notified whether the change has been made or not.

Under the Personal Health Information Protection Act (PHIPA), the hospital is not required to make corrections to information that is irrelevant to your care or information that consists of a professional opinion or observation that a health care provider has made in good faith about you. Under PHIPA, you have the right to prepare a concise Statement of Disagreement that sets out the corrections that CMH has refused to make. CMH will attach this Statement as part of the records.

Please note CMH does not correct external documentation – patients will need to contact the organization directly. Please contact HIM manager if you have any further questions or concerns about corrections.

1. What is privacy?
   • It is your right as a patient to determine when, how, and to what extent you share your personal health information about yourself with others.
2. What is confidentiality?
   • Protecting your information after it is collected. This means that the staff members, physicians and volunteers must not talk about or disclose your personal health information to anyone other than you, your substitute decision maker where applicable, or other staff or health care members that have a need to know.
3. What is Security?
   • Physically and technologically protecting your information after it is collected. This means that staff members, physicians and volunteers will physically protect your information. For instance we lock file cabinets, store records in secure areas, log off computers, etc. At Cambridge Memorial Hospital we only provide computer access to agents necessary to perform their job.
4. Who is Circle of Care?

   *In some cases we are regulated to disclose personal health information without consent.*

   • In a physician’s office, the circle of care would include:
     • the physician
     • the nurse
     • a specialist or other health care provider referred by the physician
     • any other health care professional selected by the patient, such as a registered dietitian, pharmacist or physiotherapist
   • In a hospital, the circle of care would include:
     • the attending physician
     • the health care team (residents, nurses, registered dietitians, technicians, clinical clerks and employees assigned to the patient) who have direct responsibilities of providing care to the individual.
   • The circle of care does not include:
     • A physician who is not part of the direct or follow-up treatment of an individual;
     • A medical officer of health or a board of health;
     • An evaluator under the Health Care Consent Act, 1996;
     • An assessor under the Substitute Decisions Act, 1992;
     • The Minister, together with the Ministry of Health and Long-Term Care; and
     • Canadian Blood Services
5. Does the hospital share any of my information with other organizations for reasons other than to provide me with care?
   • Not without your consent, or unless we are regulated to do so.
6. Who is a Substitute Decision-Maker.
   • An individual who makes decisions on your behalf for treatment, sharing and accessing your Personal Health Information. This person may be your power of attorney, parent, spouse capable child (at least 16 yrs old), or a person that you have chosen to make decisions for you.
7. What should I include in my request to access my Personal Health Information?
   • The written request for access must include your name, date of birth, mailing address as well as a description of the information you are requesting. The request must be dated, signed by you and witnessed by another person.
8. How long is my personal health information kept?
   • The Public Hospitals Act states we must keep your personal health information for a minimum of 10 years after you turn 18 years of age.
   • The Public Hospitals Act also states that we are required to keep your radiology film for a minimum of 5 years after you turn 18 years of age.
9. Can my family see my Personal Health Information?
   • Not without your consent, or consent of your substitute decision maker where applicable. In the event of your death, we would still require consent from the highest authority such as the Estate Trustee to provide access to family members.
10. Can you provide me with examples of when I may be required to provide consent, and tell me what happens if I am unable to provide consent?
    • Consent is required for; Insurance Companies, Lawyers, Police, Researchers, Employers, etc.
    • Cambridge Memorial Hospital will not provide access to your Personal Health Information to any individual or organization outside your health care plan, unless we are regulated to do so.
    • If you are unable to provide consent directly to the hospital, your substitute decision maker such as your power of attorney, parent, spouse, or capable child must sign the consent. The person is bound by law to act on your behalf and to make decisions based on their belief of what you would wish to be done if you were able to decide yourself.
11. Can all hospital staff access my Personal Health Information?
    • No, access is only provided to staff who have a “need to know” to carry out their duties
    • Healthcare professionals directly involved in your care may access your personal health information
    • Staff members in other areas of the Hospital that are not involved in your healthcare may have access to your Personal Health Information for purposes of managing the health care system. For instance, the finance department has access to information to facilitate payment of your bill
    • Privacy audits are performed to ensure that staff who access your records have a need to know
12. Will the hospital share information about my hospital visit with my family physician?
    • CMH provides electronic access to personal health information to Physicians (not all physicians have electronic access)
    • We also share your personal health information to a treating physician upon request e.g. fax your test results, physician reports etc. for provision of care.
13. If I am a youth, do I need parental consent if I wish to access my personal health information?
    • Access is determined by the capacity of the individual. If a Health Care Practitioner determines that you do not have capacity, then we would require consent from your custodial parent or legal guardian. If you are considered to be capable, then you may access your Personal Health Information without parental consent.
14. What happens if I am inquiring about records for a deceased patient?
    • To obtain records for individuals who are deceased, proof of executorship or legal signing authority must be submitted with the request.

Health Care Consent Act
A Guide to the Personal Health Information Protection Act
A Guide to the Personal Health Information Protection Act- Frequently Asked Questions