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Health Information FAQs

How do I obtain my Health Record or Diagnostic Image?
If you were a patient of Southlake Regional Health Centre, you can receive a copy of your health records for personal, legal or insurance use by submitting a signed Access to Personal Health Information and Disclosure Consent Form. This form allows us to release the records to you. Please note that you must provide photo I.D. to pick up your records. A basic search charge/s will apply (refer to table below).

What happens if I want my record or diagnostic image released to another individual?
Whether you want your records released to a relative or friend, you must submit a signed Access to Personal Health Information and Disclosure Consent Form. This form allows us to release the records.

You must alsoprovide a written note, signed and dated, permitting that individual to pick up the records. The individual picking up the records on your behalf must show their photo I.D.
Access to Personal Health Information and Disclosure Consent Form

Will the hospital have all my records on file?
Health Information is responsible for the release of patient health information for the timelines required by law. Currently, we are responsible to keep patient records for 10 years. If the patient was a child, the records are kept for 10 years past the year the patient reaches their 18th birthday.

We also release diagnostic images on CD or film. By law we are required to keep the images for 5 years from the exam date. If the diagnostic image was of the breast then we mustretainit for 10 years. If the patient was a child the mentioned timelines apply once the patient has reached their 18th birthday.

Do I need parental consent if I am a youth?
If the patient is 15 years of age or younger, parental consent is required. If the patient is 16 years of age or older, they are capable of requesting their own records and can consent to disclosing their health information.

What happens if I am inquiring about records for a deceased patient?
To obtain records for individuals who are deceased, proof of executorships or legal signing authority must be submitted with the request. The Power of Attorney does not have the right to access records of a deceased patient.

How do I go about requesting birth/death/proof of hospitalization information?
If you are looking for birth/death/proof of hospitalization information (e.g. proof of birth/death, time of birth/death), submit a signed Access to Personal Health Information and Disclosure Consent Form. This form allows us to release the records to you or another authorized individual of your choice (we need proper documents to release to another individual, their photo I.D. and a permission letter from you). Print and complete the form and bring it with you to request your records. You must provide photo I.D. to pick up your records.

I am an insurance company or lawyer requiring a patient's records for a claim.
The Release of Information team requires an original request from the requester stating what is needed. Included with the request must be an original signed consent of patient/client or substitute decision maker with the paperwork proving such.

We no longer require prepayment. Once we receive the request with all proper documentation, we invoice for the full amount. When the payment in full is received, the records are released.

Forward these requests to the Release of Information Team in the Health Information Department.

What is the cost of obtaining my medical information?
There is an administrative cost for non-medical requests.
Charges are as follows:
Item Description Fee Additional Fee
Medical Records on CD Providing a PDF copy of patient records on CD. (encrypted) $30.00 .50¢ for each page. (no free pages)
Medical Records paper copy For making and providing photocopies or computer printouts of a record. $30.00 .25¢ for each page after the first 20 pages
Microfilm/Microfiche for records older than 2006 For making and providing a paper copy of a record from microfilm or microfiche. $30.00 .50¢ per page (no free pages)
Computer Disk For making and providing a floppy disk or a computer disk containing a copy of a record stored in electronic format. $30.00 .50¢ cents per page
X Ray, MRI, CT Scans For producing a record stored on medical film, including x-ray, CT and MRI films.
(Clarified with IPC this includes converting film image to digital image)
$30.00 $5.00 per film
Reviewing the Record For supervising an individual examination of original records. $30.00 $6.75 for every 15 minutes after the first 15 minutes
Review of Record by a Physician/Clinician For the review by a health information custodian or an agent of the custodian of the contents of a record to determine if the record contains personal health information to which access may be refused. $30.00 $45.00 for every 15 minutes after the first 15 minutes
Letter of Visit History

Blood Type Letter

Death/Birth Verification Letter

Flat Fee for any type of letter. $30.00 no additional fees

Fees not indicated above:

Requester Description Fee
Urgent/Stat Requests


Insurance Companies

Consulting Firms

Within 48 hrs Additional fee of $300.00 on top of scheduled fee
CD DI images copied to a disk $10.00 per CD
WSIB Flat Fee $48.15
College of Physicians and Surgeons Flat Fee $0.25/page
College of Nurses of Ontario Flat Fee $0.25/page
Off Site Retrieval Additional Surcharge $25.00
Clinical Trials anonamous CD DI Images $52.00 per CD
Research As per ICES November 1, 2011 memo agreeing to a 2% increase from the Fiscal Year 2011-12 fee of $4.20/chart. Hospitals will also be reimbursed for off-site storage 2012-13 –$4.28/chart




Southlake Regional Health Centre
596 Davis Drive, Newmarket, Ontario   L3Y 2P9
Tel: 905-895-4521   |   TTY: 905-952-3062
Copyright © 2012 Southlake Regional Health Centre