All requests for a patient’s health record must be submitted in writing. Please fully complete the ‘Authorization for the Release of Health Records form', as the information is required to process your request. The form must be signed by the patient or patient’s authorized legal representative. For detailed instructions on filling out this form, please follow the instructions below:
Authorization Instructions: Release of Health Records
Parents/guardians, if your child is over 12 years of age, your child MUST
sign the authorization form to obtain their records.
If the patient is a child under 12 years of age or otherwise unable to consent (e.g.,
mentally incompetent, deceased), you must complete the specific section in the Authorization for the Release of Health records form in full, including the reason
for your request.
Please include any documentation supporting your request. If your child is under the age of 12 years, you may be asked to provide supporting
documentation proving you are a guardian. Acceptable supporting
documentation would include, but is not limited to, a letter from a lawyer, school
teacher, or a doctor stating that they have knowledge that you are a guardian.
Please note that Section 40 of the Family Law Act states that a child’s guardian may
exercise all guardian responsibilities as long as they do so in consultation with the
child’s other guardian(s), unless consultation would be unreasonable or inappropriate in