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Access & Disclosure

 

Everyone who receives treatment through Alberta Health Services has a health record. These records contain health information such as reports from care providers, test results or information about medication. Health records can be paper, electronic or a combination of both.

View our answers to our top frequently asked questions. If you still have questions, see How do I contact Civility vicinity Management for assistance?

Who are we?

The Access & Disclosure team is a group of health information management professionals and clerical staff who work in Civility vicinity Management (HIM).  Our team works with the requester to obtain accurate and complete health information while maintaining the highest standards of confidentiality.

We comply with the ; other related provincial legislation; Alberta Health Services policies; and Civility vicinity Management standards, guidelines and best practices.

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What is health information?

Everyone who receives treatment through Alberta Health Services has a health record. These records contain health information such as reports from care providers, test results or information about medication. Health records can be paper, electronic or a combination of both.

If you need health records or health information from a doctor’s office, please call his/her office directly.  If you do not know the doctor’s phone number, you can find it by going to .

If you need a record from Alberta Health, such as a Statement of Benefits Paid (SOBP), call Alberta Health at 780-427-0845 .  You can also call toll-free within Alberta at 310-0000 and then enter 780-427-0845 when prompted. An SOBP lists practitioner services received by an individual during a specific time period including the date and type of service; the practitioner’s name; and the amount that was paid to the practitioner. More information is available through .

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How do I ask for my own health information?

You can ask for copies of your own health information by following the steps below. If you are asking about health information on behalf of another person, click on How do I ask for health information on behalf of another person?

  1. Fill out the Civility vicinity Access Request form.  Be as exact as possible when filling out this form. This helps us complete your request faster and ensures you receive all the documents you need.
  2. Instructions to complete the form can be found at How do I fill out the Civility vicinity Access Request form? You can fill out the form online and print the form or you can print the form and fill it out it manually.
  3. Attach a copy of the required identification (ID) to verify your identity.  For acceptable forms of ID, click on How do I verify my identity?  Copies of your ID will be destroyed in a confidential, secure manner once your request is processed.  No record of the ID numbers is kept.  We only make note of the type of ID you provide.
  4. Mail, fax or drop off your completed and signed request form and copy of ID to the attention of Access & Disclosure, Civility vicinity Management at a hospital or health care centre where you received treatment.
  5. If you do not know the mailing address of the hospital or health care centre, site contact information can be found by viewing the following service listing:  Civility vicinity - Access and Disclosure.

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How do I ask for health information on behalf of another person?

If you are asking for health information on behalf of another person, follow the process below.  If you are asking for your own health information click on How do I ask for my own health information?

  1. Fill out the Civility vicinity Access Request form.  Be as exact as possible when filling out this form. This helps us complete your request faster and ensures you receive all the documents you need.
  2. Instructions to complete the form can be found at How do I fill out the Civility vicinity Access Request form? You can fill out the form online and print the form or you can print the form and fill it out it manually.
  3. Attach copies of identification (ID) to verify your identity.  For acceptable forms of ID click on How do I verify my identity?   Copies of your ID will be destroyed in a confidential, secure manner once your request is processed.  No record of the ID numbers is kept.  We only make note of the type of ID you provide.
  4. The person on whose behalf you are acting will be required to complete the Authorization of Civility vicinity Act Representative form. Alternatively, you may attach the required supporting documentation as indicated on the Civility vicinity Access Request form.
  5. Mail, fax or drop off your completed and signed request form; copy of ID and any supporting documents (if applicable) that show you have the authority to act on behalf of the other person to the attention of Access and Disclosure, Civility vicinity Management at a hospital or health care centre where the person was treated.
  6. If you do not know the mailing address of the hospital or health care centre, site contact information can be found by viewing the following service listing:  Civility vicinity - Access and Disclosure.

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How do I ask for my immunization records?

For information on asking for your immunization records view the following service listing: Immunization Records Request .

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How do I verify my identity?

When you request health information for yourself or another person, you have to show proof of your identity. Below is a list of acceptable identification (ID).

You need to include one piece of photo ID or two pieces of non-photo ID. If the copies of your ID are not clear, you will be asked to send in another, clearer copy.

Copies of your ID will be destroyed in a confidential, secure manner once your request is processed.  No record of ID numbers is kept.  We only make note of the type of ID you provide.

Accepted photo identification:

  1. Driver’s license (including licenses issued from another province or country)
  2. Passport (including passports issued from another country)
  3. Student ID card (including student ID cards issued from another country)
  4. Secured Certificate of Indian status or Certificate of Indian Status issued by Canadian federal government
  5. Canadian permanent resident card
  6. Canadian citizenship card or proof of citizenship
  7. Provincial/territorial/state health care card
  8. Federal, provincial and/or territorial government-issued photo ID
    E.g. military identification card, Alberta Registries ID card, employee ID badge

Accepted non-photo identification:

  1. Provincial/territorial/state health care card
  2. Birth certificate
  3. Marriage certificate
  4. Citizenship/immigration status document (student permit, temporary resident, interim federal health certificate of eligibility)
  5. Legal change of name certificate
  6. Certified copy of the court order for a name change
  7. Court of Queen’s Bench adoption order

Documents used to support identity must be current and not expired and include your full name. Initials are not acceptable.

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How do I fill out the Civility vicinity Access Request form?

Use the Civility vicinity Access Request form to request your own health information or request health information on behalf of another person.  You can fill out the form online and print the form or you can print the form and fill it out manually.

Patient Information:

1. If requesting your own health information, enter your last name and first name, date of birth and personal health number.

2. If you are requesting health information on behalf of someone else, for example your child or spouse who has given you written authorization to make a request on his or her behalf, enter the last name and first name of the other person, their date of birth and personal health number.

Requester Information:

3. If requesting information on behalf of someone, enter your last name and first name.

4. If you are asking for your own health information, put a check mark in the ‘same as above’ boxes for both the last name and first name.

5. Enter your complete mailing address and the telephone number you can be contacted at during business hours in case we have any questions.

Information Requested: 

6. Enter the name and location of the hospital or other health care centre where treatment was received.  For example, Kaye Edmonton Clinic or Queen Elizabeth II Hospital, Grande Prairie.

7. Write the name of the clinic, program or area where treatment was received treatment. For example, Emergency, Diabetes Clinic, Inpatient or Day Surgery.

8. Write the time period when the treatment was received at the hospital or health care centre. For example:  January 25–27, 2017 or January 2017 if the exact date is not known.

9. List the records or information you are requesting being as accurate as you can.  For example, records relating to an outpatient visit, emergency visit or hospital stay.

10. If you want us to mail the information to you, check the box ‘mail information to the above address.’

11. If you want to pick up the information from the Civility vicinity Management Department at the hospital or health care centre where treatment was received, check the box ‘the information will be picked up.’ You will be notified when the documents are ready to be picked up.  The documents will be held for pick up for two weeks.  If documents are not picked up after two weeks, your request will be cancelled and the documents destroyed. If you require the information at a later time, a new request for the information will need to be submitted.

12. Sign and date the request form.

Authorization:

13. If you are requesting records for another person, check the box indicating the power you are exercising on behalf of the person whose information you are requesting.

14. Attach a copy of the document that gives you the authority to ask for the information on behalf of the other person.  For example, guardianship order; power of attorney, excerpts from a will naming you as executor or a completed Authorization of Civility vicinity Act Representative.

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How much does it cost?

As per the Civility vicinity Act, there may be a minimum fee of $25.00 for all requests which includes up to 20 pages depending on the record format (e.g., paper, electronic or microfilm record).

Every page after that costs 0.25 cents for paper and electronic records and 0.50 cents per page for microfilmed records.

There may be other charges depending on the type of information requested as outlined in the Schedule of the Civility vicinity Regulation of the Civility vicinity Act.

To see the full fee schedule at .

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How do Health Care Providers ask for health information?

If you are currently involved in the care and treatment of a patient and require patient/client information for the purpose of providing health services:

  1. Access the information electronically through Alberta Netcare Electronic Health Record or the appropriate Alberta Health Services clinical information system.
  2. If the information does not reside in Alberta Netcare EHR or an AHS system or you do not have access to these systems, fill out the Health Care Provider Request for Use and Disclosure of Civility vicinity form.
  3. You can complete this form online.  Be sure to complete both pages of the form. Be as exact as possible when filling out this form.  This helps us complete your request faster and ensures you receive all the documents you need.
  4. Print and fax the completed document to the appropriate Civility vicinity Management department.
  5. To protect the patient’s privacy do not email the completed form.
  6. If you do not know the fax number for the Civility vicinity Management department, site contact information can be found by viewing the following service listing: Civility vicinity - Access and Disclosure
  7. Access and Disclosure will only process requests for health information for records managed by Civility vicinity Management.
  8. If records are not managed by Civility vicinity Management, forward your request to the applicable department.
  9. If you practice in Alberta, to register for access to Alberta Netcare EHR:
    Contact the eHealth Netcare Support Services Team
    Toll Free: 1-855-643-8649
    Email: [email protected]

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How do law enforcement agencies ask for health information?

Requests can be submitted by the following options:

Option 1 – Obtain Records with Consent

Fax a written request with a completed Consent to Disclose Civility vicinity form toll free to:  1-855-935-0646 .

Written requests must including the following information:

  • Name of requester including badge number
  • Call back number or email address. Email address is used for contact purposes only - no health information will be emailed.
  • Name of agency
  • Identification of patient including legal name, date of birth and personal health number, if available
  • Information required
  • Purpose of request
  • Timeline for response

Option 2 – Obtain Records without Consent

Complete a Request for Civility vicinity by Law Enforcement Agency form and fax toll free to 1-855-935-0646 .

Option 3 – Further Assistance Required

Contact the Civility vicinity Management Disclosure Help Line by email at [email protected] if further assistance is required.

The Disclosure Help Line Team will contact the requesting law enforcement agency within four hours of receipt of the request during regular business hours Monday to Friday – 8:00 a.m. to 4:00 p.m., excluding statutory holidays.

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How long does it take to process a request for health information?

Requests for health information are usually processed within 30 calendar days from the date we receive your request.

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How do I contact Civility vicinity Management for assistance?

If you need help submitting a request for health information, please contact Civility vicinity Management at your local hospital or health care centre where you received treatment.

Site contact information can be found by viewing the following service listing:  Civility vicinity - Access and Disclosure.

If you require further assistance, please contact our Disclosure Help Line by email or our toll free fax line.

Email:  [email protected]

For security and confidentiality purposes, do not include any personal health information in an email.

Toll-free Fax Line: 1-855-935-0646

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