Authorization to Release Personal Health Information

For your protection, a copy of a health record will not be released to third parties without your written authorization. Personal health information can not be released over the telephone and we can not accept telephone requests.

Please complete the Authorization to Release Personal Health Information form. This can be printed from the website or picked up from the Patient Records Department at KGH or HDH. Please ensure that all information is completed on the form, dated and signed. This authorization is valid for 6 months and pertains to the release of information specific to treatment received on or before the date signed.

To expedite your request, you may fax your request to our department:
613-542-8071, however, the original must be mailed or dropped off. We do not accept requests sent via e-mail. Our hospital policy does not allow us to send personal health information by e-mail as this is not a secure method of transmission.