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SickKids CCMH
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Requesting your health information

A request can be made by completing the Consent to disclose Personal Health Information form. Ensure the consent is:

Complete: All fields are filled out and information being requested is clearly stated.

Dated: Consent is valid for 90 days from the date the consent was signed.

Signed: Consent must be signed by any patient/client 12 years of age or older. Consent will be accepted from a parent, guardian or substitute decision-maker (SDM) if the patient/client is less than 12 years old or is deemed incapable of consenting. The SDM must be a person authorized by PHIPA to consent on behalf of the individual, to disclose PHI about the individual.

A patient/client may withdraw consent at anytime by notifying the Health Records department in writing indicating that they no longer consent to the disclosure of PHI.

Witnessed: Where possible consent may contain a signature from a witness, including the date of witness of said signature. A witness should ideally be a neutral third party. This can be the service provider or legal representation.

Note: You may be asked to provide us with additional documentation to provide proof of identity and/or legal signing authority such as a copy of photo ID with your signature, proof of power of attorney or custody, and/or death certificate.

How to submit your consent

By mail:
Attn: Health Records department
SickKids Centre for Community Mental Health
440 Jarvis St.
Toronto, ON  M4Y 2H4

By fax: 416-373-2003 
In person: At reception desk

What types of information to request?

Assessment notes: Most recent assessments will be provided, unless otherwise specified.

Contact notes: Specify date or range of dates of the note(s).

Closing/discharge summary: Summarizing report done at the end of a treatment program.

Transfer of record: Copy of the complete health record. Please note this will not include raw data as the results of all raw data collected are summarized in the assessment reports.

Other: Specify type of request if different from that which is listed on the consent form.