Health Information Request – Third-Party Requests

A written request is required with details about client information (name, PHN or DOB) and health records requested.

Heath InformationAccess Request Form
  • Attach Consent to Disclose Health Information form signed by the client or authorized rep.
  • If signing the consent form on behalf of resident/client, provide copy of supporting documents for proof of authorization.
  • Family members ,who are not authorized representatives, are welcome to use the Health Information Request Form.
  • Please submit all requests to [email protected]

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