To submit a request, please complete the Consent for Disclosure of Personal Health Information form. To avoid delays ensure the consent form is complete, dated, signed and witnessed.
The consent must be signed by the patient 12 years of age or older. Parental consent is accepted if the patient is less than 12 years of age or is incapable of consenting. If there is a conflict between the child and the parent, the capable child’s decision prevails with respect to consent.
Consent is valid for 12 months and pertains only to what has been authorized for disclosure on or prior to the signature date.
Patients may withdraw their consent at any time. Please notify the Health Records Department in writing if you no longer consent to the disclosure of your Personal Health Information.
Please Note: In accordance with the Personal Health Information Protection Act (PHIPA), the Health Records Department will process your request within 30 days. If the request is urgent please specify on the consent form.
We require the following to be included as part of the authorization:
- Direct the authorization to The Hospital for Sick Children
- Must include a name, complete address and phone number of the person or facility the information is being sent to
- Patient’s name at time of admission i.e.(maiden name), date of birth and reason for your request
- Medical Record Number (MRN). If this is unknown, leave blank
- Health Card Number (HCN). If this is unknown, leave blank
- An authorization must be fully completed, dated, signed and signature must be witnessed
- Consent must be signed on/after the treatment date.
- The original consent is required from law offices, insurance companies and consulting firms. It may be requested from other third party requestors.
Completed consent forms can be submitted by:
Mail: Release of Information, Health Records Department, The Hospital for Sick Children, Room S203, 555 University Avenue, Toronto, Ontario M5X 1G8
In person: The Health Records Department is located on the Service (S) level of the hospital. Take the elevator in front of Shoppers Drug Mart at the University Avenue entrance on the main floor, one floor down to Service level and follow the orange sign.
What to request:
- Specified Reports
For example; a discharge summary, operative reports, clinic note, lab reports, EEG report, MRI report, visit history (dates of visits) or other specific documentation.
- Summary of Record (Sent to health-care providers for ongoing care)
Includes discharge summaries, clinic notes, consults, operative reports, MRI and CT scan reports, major test results, and other specified test results.
- Complete health record
A copy of all SickKids reports in the health record.
- Diagnostic Images on CD
The Health Records Department provides diagnostic imaging reports only. If you require diagnostic images on CD, please fax a completed Consent for Disclosure of Personal Health Information form to the Diagnostic Imaging Department directly.