My Medical
record

Accessing Your Health Record

Collection, use, access and/or disclosure of personal health information is governed by Ontario law (Personal Health Information Protection Act 2004). You have a right, by law, to access your own hospital health record either by viewing or requesting a copy.

Requesting a Copy of your Own Health Record
You can obtain a copy of your own hospital health record by filling out the online consent form. This form can then be printed out, signed and submitted to the Health Records Department by e-mail, fax or in person.

Request to Access Personal Health Information Form 
(This file is a fillable form and needs to be saved on your computer to  fill out electronically, or print to fill out by hand.)

You may also access records through MyChart online.  

Obtaining a Copy of your Health Record for a Third Party
You can request that a copy of your hospital health record be released to a lawyer, insurance company, or any other third party specified by you, by filling out the online consent form. This can then be printed out, signed and submitted to the Health Records Department by e-mail, fax or in person.

Third Party Release Form 
(This file is a fillable form and needs to be saved on your computer to  fill out electronically, or print to fill out by hand.)

Your Privacy is Important to Us
Listowel Wingham Hospitals Alliance is committed to keeping your personal health information safe and confidential.

 
Contact Us

Listowel Memorial Hospital
Telephone: (519) 291-3120 Ext.6207
Fax: (519) 292-2131

Wingham and District Hospital
Telephone: (519) 357-3210 Ext.5230
Fax: (519) 357-3904

See Below for Frequently Asked Questions

What is a Health Record?

A health record is comprised of:

  • Personal information (e.g. name, date of birth, gender, address, and extended health insurance numbers).
  • Personal health information (e.g. Health Card Number, information relating to previous health problems, diagnosis, the record of your visits to the hospital and what health care we provide to you during those visits).

This information can be gathered and stored in several ways:

  • A hard copy hospital chart maintained by Health Records
  • An electronic patient record
  • Documents created and stored in patient care areas and private offices
  • Diagnostic images and reports
  • Lab specimens and reports
  • Photographs
  • Videos
How is Your Health Information Used?

The information we collect from you is used:

  • To provide you with quality health care and followup care in the community
  • To carry out quality assurance to make us better
  • For patient satisfaction surveys to see how we are doing; and to comply with legal and regulatory requirements
  • For research to make the Listowel Wingham Hospitals Alliance staff the best we can be and to help develop new treatments and technologies for the future
  • For education to keep current health care practitioners up to date and to train new health care practitioners for the future
What Information Does the Hospital Collect?

In order to provide you with quality health care we collect both personal and health information from you.

  • Your legal name, date of birth, address, health card number and extended health insurance numbers are examples of personal information.
  • Your health history, the records of your visits to the hospital and what health care we provide to you during those visits are examples of your health information
Obtaining a Copy of a Health Record?

For Another Individual?

Consent for the collection, use and/or disclosure of personal health information is obtained from the patient, regardless of age, if the patient is capable of understanding the information presented to them and the impact of consenting or declining. If the patient is not capable, consent is obtained from the Substitute Decision Maker (SDM) who may be:

  • 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.

For Other 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.

For a Deceased Individual?
If you are requesting a copy of the hospital record of a patient that is deceased, you must submit proof of your legal signing authority as well as filling out the online consent form. This can then be printed out, signed and submitted to the Health Records Department.

You must provide either:

  • a copy of the deceased person’s Will naming you as the Executor or,
  • in the absence of a Will, a letter notarized by a lawyer to confirm your legal signing authority.
What is the Cost for a Request?
There is an administrative fee associated with a request to view and/or obtain a photocopy of your health record. The fee for copying varies with the size of the record. For more information about these fees, please contact the Health Records Department.
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