My Health Care Information

You have the right to access the personal health information contained in your medical record, with some limited exceptions under the law. All requests are managed by the Release of Information Department at Kingston Health Sciences Centre (KHSC).

Contact Information: 
Release of Information – KHSC
76 Stuart St, Kingston, ON K7L 2V7
Telephone:  613-549-6666 ext. 64949
Fax: 613-542-8071
Email: @email

Choose the option that applies to your request:

1. Access to your own medical record. To request a copy of your personal health record, complete this form: Request for Access to Personal Health Record Form
2. Access to recent diagnostic reports only (past 30 days). To request recent results such as blood work, imaging, or pulmonary function tests, complete this form: Request for Receipt of Diagnostic Testing Reports Form
3. Release of your information to a third party. To authorize KHSC to send your health information to another person or organization (e.g., insurance company, lawyer, another hospital), complete this form:  Authorization to Release PHI to a Third Party Form

Completed forms can be:
•    Emailed to @email
•    Faxed to 613-542-8071
•    Mailed to the address listed above

Note: Medical records and diagnostic reports are released by mail or in person, as arranged with Health Information Services.  Reports cannot be emailed for privacy reasons.

Personal health information includes information such as your name, date of birth, address, health history and records of your visits to the hospital and the care that you received during those visits. Your medical record contains your personal health information. Occasionally, we collect personal health information about you from other health information organizations or providers if we have obtained your consent, or as the law permits.

The law allows the hospital to charge a fee to recover costs. When you submit the form you will be informed if a fee applies. 

• Release of Information fee schedule 

Only those who need it to provide you with health care. Your health care team needs access in order to plan and deliver your health care. This may include sharing your health information with:

• Other approved health information organizations or providers (e.g. Community Care Access Centre, family physicians, community mental health)
• eHealth Ontario provincial electronic health record and other regional health information repositories (e.g. South East Health Integration Information Portal (SHIIP))
• Other allied health care professionals who will provide your follow-up care

Yes. We may use or share your personal health information to:

• Perform activities to improve and maintain the quality of the care that we deliver to you;
• Conduct risk management activities;
• Teach health care professionals (we use de-identified information where possible);
• Plan, administer and manage our internal operations;
• Obtain payment for delivery of your health care (e.g. from OHIP, WSIB or others);
• Fund-raise to improve our health care services and programs (information limited to name and address);
• To conduct research;
• Comply with legal and regulatory requirements.

Yes. At any time you may withdraw your consent to share your personal health information for research, fundraising or patient satisfaction surveys, etc. To do so, please ask us in writing using the form below:

• Withdrawal of Consent Form 

Yes. If you believe that factual information in your medical record is incorrect, you have the right to ask to have it corrected. 

• Request for Correction to Personal Health Record 

Your first step is to complete the form below. An interview/discussion will be arranged with the Privacy Officer/delegate and you once the form has been completed. 

• Request to Lock Personal Health Information 
• Request to revoke consent to lock Personal Health Information

There are laws that require us to retain records for periods of time; generally adult patient records are kept for 15 years following the last visit or death and children’s records are kept for 15 years past the child’s 18th birthday. *If you participated in approved health care research, your personal health information could be retained for 15 years following the completion of the research.

If you have reason to believe your privacy has been breached or accessed by a person(s) unauthorized to do so without your consent, please contact the Privacy Office at:

Privacy and Freedom of Information Office
Kingston Health Sciences Centre
76 Stuart Street
Kingston, ON K7L 2V7
Phone: (613) 549-6666 or 1-800-567-5722 Ext. 2567
Fax: (613) 548-2445
Email: Privacy@KingstonHSC.ca

You have the right to complain to the Information and Privacy Commissioner/Ontario if we have been unable to resolve your concern.

Information and Privacy Commissioner/Ontario
2 Bloor St. East, Suite 1400
Toronto, ON, M4W 1A8
Phone: 416-326-3333 or 1-800-387-0073
Fax: 416-325-9195
Website: www.ipc.on.ca

KHSC's Privacy Practices policy is available here: Privacy Practices