Medical Records Request

Records Management Ltd. retains paper and electronic medical records of physicians who practice across Canada. Please fill out the form below to request copy of your medical files.

Alternatively, you may fill out the PDF Form.

Medical Records Request

Doctor’s Name *

Approximate date of when you last saw your physician *

*Please complete this section if different from the patient.

First Name

Last Name

Phone Number

I'm the legal guardian for the following patients/minors or am otherwise authorized by law or directly by the patient to obtain their medical records.

First Patient

Patient’s Name *

Date of birth *

Last 4 digits of health card *

Phone Number *

Email *

City *

Province *

Postal Code *

Second Patient (Optional)

Patient’s Name

Date of birth

Last 4 digits of health card

Phone Number

City

Province

Postal Code

Third Patient (Optional)

Patient’s Name

Date of birth

Last 4 digits of health card

Phone Number

City

Province

Postal Code

I hereby release Records Management Ltd from any and all legal liability that may arise as a result of the duplication and/or transfer of these Medical records. I understand that any and all information in these Medical Records shall be copies and released, including but not limited to, mental health records, drug and/or alcohol abuse records and/or HIV test results, if any. This shall be Records Management’s full and sufficient authority for providing and transferring a copy of my Medical Records as indicated.

I acknowledge and accept the terms of this release and consent. *

Confidentiality Obligations: Except as otherwise provided in this Agreement, the Medical Records shall remain the exclusive property of the physician and will only be used by Records Management Ltd. for the permitted purposes provided herein or as otherwise compelled by law. The obligations to ensure and protect the confidentiality of the confidential information imposed on Records Management Ltd. in this Agreement and any obligations to provide notice under this Agreement will survive the expiration or termination, as the case may be, of this Agreement. Records Management Ltd agrees to provide access to the original individual’s medical file at no cost only when patient’s identity is confirmed and sufficient notice is given. Files are strictly reviewed by patients on site (office area). Records Management Ltd. agrees to retain all confidential information at the usual place of business and to store all confidential information separate from other information and documents held in the same location. Further, the confidential information is not to be used, reproduced, transformed, or stored on a computer device that is accessible to person to whom disclosure may not be made, as set out in this Agreement.
Miscellaneous Personal Information: The patient consents to Records Management Ltd.’s collection, use and disclosure of all personal information disclosed to Records Management Ltd. in this form, in the application process or in the ongoing administration of this Agreement. Records Management Ltd. will only collect or disclose the patient’s personal information to identify and contact the patient or to perform any other necessary functions relating to the administration of this Agreement or otherwise as required by law. A facsimile copy of this Agreement with facsimile signatures will be treated as an original and will be admissible as evidence of this Agreement. This Agreement shall be construed according to the laws of Province of Ontario. Records Management Ltd. is entitled to conduct a personal investigation or credit check upon the patient, subject to applicable legislation. The parties agree that this document be written in English. This Agreement shall not become binding upon Records Management Ltd. until accepted by Records Management Ltd. This Agreement is binding on the patient’s heirs, executors, administrators, successors and permitted assignees. If more than one patient is named under this Agreement, the liability of each patient shall be joint and several. Clerical errors shall not affect the validity of this Agreement and Records Management Ltd. shall be entitled to correct all clerical errors provided that the patient is given notice of the correction. This Agreement constitutes the entire Agreement between the patient and Records Management Ltd. Records Management Ltd. has reated and implemented a privacy policy in compliance with PIPEDA and PHIPA to ensure that no personal information is collected, used or disclosed without the consent of the patient involved and / or Dr. or as otherwise required by law.

Disclaimer

You can obtain a copy of your medical record. The original is kept by the physician until destruction. Patients must sign a Consent form to release information. We provide the form upon request. Copying files isn’t covered by OHIP. Fees are reasonable and follow guidelines. Records are released once authorized. Call us at 1-800-775-0093 Mon-Fri, 9 am to 5 pm.

I am requesting copy of my medical chart from the practice of Dr.

Patient Records Request

If you're a patient seeking a copy of your medical files, please use this secure form

“Enjoyable and Pleasing Experience”

It gives me great pleasure to recommend Records Management Ltd. to anyone in the medical field. Their business acumen, courteous and respectful staff made the transition of my medical files from paper documents to digital images an enjoyable and pleasing experience. I was also very impressed with the way in which everything was handled, including the packing up, safe transportation, and scanning of my medical records, without any interruption to my practice.

Neither my staff nor my patients experienced any inconvenience during the changeover. The management and employees of Records Management are professional, honest and very helpful!

Thank you, Records Management, for the hard work!

Dr. Scott R. Perry M.D.

“100% Satisfied”

Throughout our correspondence, all the members of their staff that we dealt with were very professional and each one of them was precise and knowledgeable about the Law Society of Upper Canada’s file management guideline, with special attention placed on section 3.12.4 Storage of Files; 3.12.6 Retrieval of Electronic Files; 3.12.7 Destroying of Client Files of The Law Society of Upper Canada File Management Information, which exceeded my expectations.

I am 100% satisfied with my choice of selecting Records Management Ltd. for storage of our files. I must comment about Records Management Facility which is clean, secure and temperature controlled to ensure the safety and longevity of our files. Their digital system also offers a quick and easy solution to locate documents in closed and inactive files.

Please consider Records Management Ltd. for all your file scanning and storage solution. I highly recommend their services.

Once again, I would like to express my sincere gratitude to the staff of Records Management Ltd. for their impeccable service.

Mila Popova, Summit Legal Services

“Quickly and Efficiently”

As a neurologist with an exceptionally busy practice, it is imperative that my files are kept in an orderly fashion and easily accessible. Records Management came in and converted my paper files to digital images by scanning my active patient’s records, quickly and efficiently, which I can now use on a daily basis to practice my specialty and do research.

I found Records Management to be extremely thorough, and professional. I would not hesitate to recommend their services to any of my colleagues.

Joseph Chu MD, Speciality Neurology, Electromyography and Internal Medicine

“The Quality of Scanning is Excellent”

During May 2011 AMD Diagnostics Inc engaged Records Management LTD to carry out the scanning of cardiac patient’s records, which were returned to us in PDF format. The work provided by Records Management was excellent and the employees’ were professional, efficient and courteous at all times, to the extend of prioritizing rush medical files due to upcoming appointments, and keeping me advised of the progress of the works being carried out. The whole operation has been undertaken without any problems and the quality of scanning is excellent.

We would highly recommend Records Management to other organizations seeking a proficient service and would undoubtedly utilize Records Management in the future as our preferred scanning service for AMD. Tha scanned data compliments the operational needs of AMD in use by the service. We look forward to undertaking more work with Records Management to further improve the services to our patients.

Melanie Vincente, AMD Diagnostics Inc.

“Exemplary in Every Respect”

The service recently provided to me by Records Management Ltd, was exemplary in every respect.

I am therefore, pleased to give my unreserved recommendation of this company to any of my medical colleagues who may be considering retirement from their practice, closure of practice for any reason, as well as, storage and/or shredding of documents.

Commendations from a satisfied client.

Dr. H. David Sackin M.D.

“Integrity is Beyond Reproach”

I had imagined that the transition from running a high profile medical practice to that of retiremend, would be one of stress, chaos and frustration, all of which couldn’t be further from the truth. In actual fact, the staff at Records Management, were extremely helpful, thus alleviating all my fears.

I can honestly say that Records Management offers excellent customer service, reliability, and one whose integrity is beyond reproach.

Dr. Aurea Santos Jose B.Sc., M.D., F.R.C.P., F.A.B.D.

“Easily Reachable”

They provided my patients with written mail notification of my practice relocation as soon as it becomes that I will be leaving my group in orther to build a solo practice. Their experience, strategic knowledge and tactical experience really helped me in managing a CPSO compliant notification campaign for over 1500 patients and 260 Family Physitians.

Their team is very proffecional and they get the work done fast. They are easily reachable and reply to emails and calls fast. I highly recomend them to anyone who is planning practice relocation.

Dr. Anila Seth-Sharma, MD, FRCPC

Seamless Closure After 47 Years in Practice

I recently retired after 47 years of family medicine. I am grateful to Records Management Ltd. for their professional and efficient service. The team went above and beyond to successfully reach out to all of my patients during a postal strike. I have no hesitation to highly recommend this company to close any medical practice.

Dr. Ian Sang

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Medical Records Request