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Home » Access & Privacy » The Personal Health Information Act (PHIA) » PHIA Forms

PHIA Forms

Printing Instructions

  • For English Version: Print page 1 only
  • For French Version: Print page 2 only
  • For Both English & French Versions: Print all pages

Download Forms & Guidelines

Consent to Use Personal Health Information Form (PDF, 186 KB)

  • Guidelines – English (PDF, 21 KB)
  • Guidelines – French (PDF, 23 KB)

Request to Access Personal Health Information Form (PDF, 192 KB)

  • Guidelines – English (PDF, 22 KB)
  • Guidelines – French (PDF, 24 KB)

Request to Correct Personal Health Information Form (PDF, 178 KB)

  • Guidelines – English (PDF, 21 KB)
  • Guidelines – French (PDF, 22 KB)

Consent to Disclose Personal Health Information Form (PDF, 184 KB)

  • Guidelines – English (PDF, 21 KB)
  • Guidelines – French (PDF, 23 KB)

Disclosure of Personal Health Information to Police With Consent Form (PDF, 200 KB)

  • Guidelines – English (PDF, 21 KB)

Disclosure of Personal Health Information to Police Without Consent Form (PDF, 200 KB)

  • Guidelines – English (PDF, 23 KB)

The Personal Health Information Act (PHIA) Information and Agreement for Persons Job Shadowing (PDF, 191 KB)

Information and Agreement for Visitors on Business (PDF, 181 KB)

Take Our Kids to Work Agreement (PDF, 172 KB)

  • Access & Privacy
  • The Personal Health Information Act (PHIA)
    • Your right to access your information
    • Who else can see your information
    • How to request to see or get a copy of your personal health information
    • How to request a correction to your personal health information
    • PHIA Privacy Officers
    • PHIA Guidelines
    • PHIA Forms
    • PHIA Policies
    • PHIA Training
  • The Freedom of Information and Protection of Privacy Act (FIPPA)
    • How to request records maintained by the WRHA
    • FIPPA Access and Privacy Officer and Coordinator
    • FIPPA Policies
    • FIPPA Frequently Asked Questions

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