For Our Patients

Release of Patient Information

How do I request a copy of my health record?

To release personal health information, an original consent from the patient or his/her legal representative is required. The consent must be directed to Trillium Health Centre, dated within three months, witnessed by another person and must identify specifically which visit or clinical information is being authorized to be released and to whom the information is being released.

Click here to print our Consent to Disclose, Transmittal, Access To or Examine Personal Health Information Form.

Do I need parental consent if I am a child?

Parental consent is required if the child is less than 16 years of age and not capable of consenting, otherwise the child can consent to disclosing their information. If there is a conflict between the child and the parent, the capable child's decision prevails with respect to the consent.

How do I request a copy of records for a deceased patient?

To release personal health information of a deceased patient, consent is required from the executor of the estate (with proof, copy of first and last page of Will). If no Will exists, a Certificate of Appointment of Estate Trustee is required.

Is there a fee for requesting personal health information?

There is no fee to release patient information to other health care facilities or physicians for continuity of patient care. For other purposes, an administrative charge may apply based on the current fee schedule (see below). Our Release of Patient Information area will inform you of the cost prior to completing the request.

Current Fee Schedule (April 2005):