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145 Front Street East, Unit G2 Toronto, ON M5A 1E3 Telephone: (416) 5914411 Fax: (416) 6402072Consent to Disclose Personal Health Information Pursuant to the Personal Health Information Protection

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How to fill out release of information consent

01

Obtain the release of information consent form.

02

Fill in your personal information including your name, contact information, and date of birth.

03

Specify the information you are authorizing to be released.

04

Provide the names of the individuals or organizations authorized to release and receive your information.

05

Sign and date the form to authorize the release of information.

06

Make a copy of the completed form for your records.

Who needs release of information consent?

01

Individuals who want to authorize the release of their personal information to a specific individual or organization.

02

Healthcare providers or facilities may also require release of information consent to share medical records with other healthcare providers for continuity of care.

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What is release of information consent?

Release of information consent is a document that allows an individual to authorize the disclosure of their personal health information to a designated person or entity.

Who is required to file release of information consent?

Any individual who wishes to authorize the disclosure of their personal health information is required to file release of information consent.

How to fill out release of information consent?

To fill out release of information consent, the individual must provide their name, date of birth, the name of the person or entity receiving the information, the type of information to be disclosed, and the duration of the authorization.

What is the purpose of release of information consent?

The purpose of release of information consent is to protect the privacy of an individual's personal health information and give them control over who can access their records.

What information must be reported on release of information consent?

The release of information consent must include the individual's name, date of birth, the recipient of the information, the type of information to be disclosed, and the duration of the authorization.

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