Record Access and Correction Request Form

Under the Freedom of Information and Protection of Privacy Act

If requesting access to or correction of personal information, you must provide the following:

• A photo of your valid government-issued photo identification, by itself. (e.g., driver’s license, Ontario photo card, passport)
• A photo of you holding your valid government-issued photo identification beside your face to confirm your identity.

If requesting personal information on behalf of a patient or visitor, in addition to the above, please also submit:

• A consent form, letter or email from the respective person to whom the information pertains
• A photo of the person’s government-issued photo identification
• If the person is deceased, we require documentation that validates your position of estate trustee or administrator of the estate

If requesting a correction to personal information, please upload any additional supporting documentation.

Personal information contained on this form is collected pursuant to the Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions about this collection or about the response process in general should be directed to the Freedom of Information and Privacy office by calling 905-494-2120 ext. 29466.