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.

To request copies of or to view your health record, Authorization to Disclose Personal Health Information will need 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 (address below) Attention: Health Records ROI.

Release of Info



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.


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:

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