At this time your records (this does not include images) will be provided as a pdf copy using a Secure File Transfer Protocol, for a flat fee of $40.00/patient request. When your completed request, along with the required Identification and/or Authorization has been provided, your request will be submitted for processing. When the request has been processed you will be notified to complete payment; if required through; our online payment option. Once the payment has been received the pdf file will be shared.
**Instructions for the Request, Payment and Secure File transfer here.**
If images are required with patient records, these can be obtained through Pocket Health.
Our online Request and Authorization sample form can be found here. (This form cannot be filled out.)
Along with the completed form, you will need to provide a copy/picture of your Identification and Authorization if applicable. The request will not be completed without the Identification and/or Authorization attached.
When you are ready to access your Personal Health Information (Medical reports/records, Health records/reports) you, or your substitute decision maker (a person who can make decisions on your behalf), may complete the following form:
- Request and Authorization Form (Request and Authorization Form for PHI)
• Will have to provide copy of government issued photo ID along with completed form
- Copy of Government issued Identification – i.e. Driver’s License, Health Card, Passport
- SDM/Executor-See section regarding SDM/Executor for required information. (Request and Authorization Form for PHI)
• Will have to provide copy of government issued photo ID along with completed form along with proof of SDM or executorship, or for legal custodian/parent/guardian of patient under 18 - Please provide requestor Identification, identification/birth certificate of patient and proof of custody or guardianship if applicable.
- Copy of Government issued Identification – i.e. Driver’s License, Health Card, Passport
**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. 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 message)
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 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 a paper copy of 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
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.
