Patient Request For Release of Information

​​​​Under the Ontario Legislation called the Personal Health Information Protection Act (PHIPA, 2004), patients have the right to request access to or obtain a copy of their personal health information. This request can also be made by a patient’s Substitute Decision Maker (SDM) if the patient is considered incapable for health care decisions. 

  • The individual's (patient's) guardian of the person or guardian of property
  • The individual's attorney for personal care or attorney for property
  • The individual's representative appointed by the Consent and Capacity Board
  • The individual's spouse or partner
  • A child or parent of the individual
  • A parent of the individual with only a right of access
  • A brother or sister; or
  • Any other relative.
  • In the case of a conflict, the capable patient's decision prevails with respect to consent for the collection, use and/or disclosure of their personal health information.

Patient/sdm requests for information

To request copies of your health record, please complete our authorization form Authorization to Disclose Personal Health Information .  To request access to review your health record (in person), please complete our authorization form Request for Access to Personal Health Information.  All forms are to be completed in full by the patient or, for incapable patients, the Substitute Decision Maker.  You will then need to submit the completed form to the Erie Shores HealthCare Health Records department (1st floor) or via mail to Erie Shores HealthCare Attention: Health Records ROI (address below).


Requests for health care providers:

When requested, copies of your health record may be released to health care providers outside the hospital to ensure the best continuing care for you. Your attending physician at the hospital may also share reports or summaries of your treatment at the hospital with other physicians and health care providers involved in your care to ensure they are aware of treatments or medications that may affect your ongoing care.


Healthcare providers can call the Health Record Departments or fax their request for information.


Request for deceased individual:

If you are requesting a copy of a health record of a patient that is deceased, you must submit proof of your legal signing authority (e.g. copy of Will naming you as Executor, a letter notarized by a lawyer confirming authority) together with the Authorization to Disclose Personal Health Information form.


Request for third party release:

If you require a copy of your hospital health record to be released to a lawyer, insurance company, or any other third party, please have the requesting party send their request and completed authorization form to the Health Record Department.


Release of information:

To avoid delays in release of information, please ensure the form is completed in full, signed, dated and witnessed.  If you are requesting information as the authorized Substitute Decision Maker for a patient who is incapable, you will need to verify your role by providing the necessary documentation (e.g. copy of Power of Attorney for Personal Care document).


We will process your request as quickly as possible. Please note, under the PHIPA legislation, ESHC must respond to your request no later than 30 days after receiving the completed request. If ESHC is unable to respond to your request within the 30 days, we will notify you in writing with the reason why we cannot provide the request within 30 days and time line for length of extension to complete your request. 


​How can you contact ESHC if you require assistance?

Our Health Record Department is open 8 am to 4 pm Monday to Friday. When calling Health Records, please note you will be greeted by an answering machine. Please leave a detailed message and the Health Records Department will respond to your call in a timely fashion. The Health Record Department can be reached as below:

Contact us:
Erie Shores HealthCare Health Records Department

194 Talbot Street West (1st Floor), Leamington, ON N8H 1N9

Telephone number: 519-326-2373 ext. 4510

Fax: 519-322-0598