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Making a Request


Under Ontario's Personal Health Information Protection Act (PHIPA), you have a right to access your own personal health information. Your medical record is highly confidential and we release copies only on your authorization.

 

Questions about Release of Information or Making a Request, please call or come by:
Office Hours: 8:00am – 4:00pm, Monday to Friday, closed Statutory Holidays
Phone: 416-242-1000 ext. 82300, press 1
Fax: 416-242-1085


How to complete the Consent for Disclosure of Personal Health Information form:


Requests for access can be made to Humber River Hospital by completing the Consent for Disclosure of Personal Health Information form. (PDF) This electronic form can not be saved so you will need to print the form, complete and sign, then mail or deliver the form.


Each consent form needs to include:

  1. Patient Information: First and Last Name, Date of Birth, Address and Phone Number
  2. Doctor Information or to whom the records are to be given: Name, Address, Phone and Fax Number
  3. Specify Records: exact specification of which records are required (Date Ranges, Type of Care, Kind of Records , for example: 01/04/08, ER visit, radiology and lab results)
  4. Signatures: Original signature of the patient (16 years of age or older and competent) and an original signature of a non-family witness. (18 years of age or older and competent).
  5. Date: The date the authorization is signed. The date must be within 90 days.
  6. Address to: Humber River Hospital
  7. Send to the appropriate location: Wilson Site (1235 Wilson Avenue, Toronto, Ontario, M3M 0B2)

Processing the Request


You will be required to provide us with valid photo identification or other proof of identity prior to receiving the personal health information. If you are a person's Substitute Decision maker please include the related documents with your request.


All requests for Health Records need proper authorization and in some instances, there is a fee. Once we receive the consent form, then a fee estimate letter will be mailed to you. Once we receive the fees then we will begin processing your request. Your request will be processed in the shortest time possible, although we have 30 days to respond to the request. We charge fees to obtain a copy for your own records, a lawyer or insurance company. In the case of Workmen's Safety and Insurance Board (WSIB), the cost is billed directly to the WSIB.


Family Physicians:


  1. We can release medical records to family physicians only if the family physician is listed in the patient record.
  2. If your family physician is not listed on your health record, then a signed consent form on physicians letterhead is accepted and can be faxed to 416-242-1085 for processing.
  3. Health records used for medical purposes and continuing care of a patient are released without a charge.

Mental Health Records:


Each mental health record must be reviewed by the psychiatric physician before being released to the patient. In some instances this may cause a request to exceed the 30 day response time.


Medical Images:


Medical Images such as X-Rays, MRI, CT or Ultrasounds should be requested from the Film Library. Requests for CD's of any Medical Imaging exams performed can be made at either site. Pick up times 7 days per week from 8 a.m. to 8 p.m.


Please ensure that you give 24 hours notice.


A letter of authorization is required for pickup of other person's CD's.


  • Wilson Site 416-242-1000 ext 63417

Cost: First time request free


Second request $40.00.


Once obtained the CD is yours, please take it back from any physician who is viewing the CD to ensure no further costs to you in the event you need another copy.


Requests for Proof of Birth/Death/Admission/Discharge Letters


For birth, death, admission and discharge letters, please complete the Consent for Disclosure of Personal Health Information (PDF Form)


Birth Certificate


The hospital does not issue birth certificates. After a birth, the hospital or midwife provides a Statement of Live Birth. This is a permanent identity record and it is needed to apply for a birth certificate from the Office of the Registrar General. To obtain a birth certificate, please contact the Office of the Registrar General at 1-800-461-2156 or through the Ministry of Health and Long-Term Care website.


Death Certificate


The hospital does not issue death certificates. A Medical Certificate of Death is completed by the hospital and is sent to the funeral home with the deceased. A Statement of Death is completed at the funeral home and the death is registered with the Office of the Registrar General at 1-800-461-2156 or through the Ministry of Health and Long-Term Care website.

Patient Care Reinvented.