How do I submit a written request?

For your protection, a copy of a health record will not be released to third parties without your written authorization. Health information cannot be released over the telephone. The Health Records Department at one hospital cannot release the health records from another hospital; for example, STEGH cannot accept a request to release/copy health records from London Health Sciences Centre (LHSC).
 
Please complete the Authorization for Release of Patient Information form. This form can be printed from our web site or picked up from the Health Records Department.
 
To avoid delay, please make sure that all information is complete on the form, and don't forget to sign and date the form. The completed form can be mailed, or dropped off in person at the Health Records Department.
 
To expedite your request, the form may be faxed (519-637-3223); however, the original must be mailed or dropped off to the hospital site where you received treatment/services.
 
For your protection, copies may not be released without the original, signed form accompanied by appropriate identification.
 
This authorization is valid for six months and pertains to the release of information that is specific to treatment/services received on or before the date signed.