Health Information Management Forms Policy & Clinical Standards DOCUMENT FINDER A searchable database of policies and clinical and non-clinical standards documents and forms. Health Information Management Work Standards HIM Work Standards (Intranet) PHIM Work Standard Library (SharePoint) Access to Health Information Forms Access to Information (ATI) - Provider Review Form (SHA 0418) (PDF 628.67 KB) Published May 9, 2024 Confidential Off Site Storage: ACCESS Information Authorized User Form (PDF 270.15 KB) Published November 28, 2022 Request for Access to Personal Health Information - Current Record (SHA 0230) (PDF 713.9 KB) Published October 30, 2023 Request for Access to Personal Health Information Form (SHA 0347) (PDF 1.12 MB) Published April 2, 2025 Request for Access to Personal Health Information on Behalf of a Patient Form (SHA 0348) (PDF 693.44 KB) Published October 23, 2024 Amendment to Personal Health Information Forms and Letter Templates Amendment Form for Health Care Providers Notation Summary (PDF 164.89 KB) Published July 28, 2023 Letter from HIM to Health Care Providers - Notice of Amendment Request Template (DOCX 147.87 KB) Published July 31, 2023 Letter to applicant - Amendment denied Template (DOCX 146.46 KB) Published July 31, 2023 Letter to applicant - Amendment made Template (DOT 316 KB) Published July 31, 2023 Request for Amendment to Personal Health Information Form (SHA 0419) (PDF 777.56 KB) Published May 9, 2024 Disclosure of Health Information Forms Consent for Disclosure of Personal Health Information for Clients (SHA 0249) (PDF 707.28 KB) Published October 23, 2024 Coroner Request Access Form (PDF 504.97 KB) Published November 22, 2022 Request for Access to Personal Health Information - Ministry of Social Services Form (PDF 738.44 KB) Published June 16, 2023 Request for Disclosure of Personal Health Information to Police With Consent Form (PDF 560.54 KB) Published June 10, 2024 Request for Disclosure of Personal Health Information to Police Without Consent Form (PDF 531.35 KB) Published June 10, 2024 SHA Requests for Personal Health Information Forms Labour & Employee Relations/Practitioner Staff Affairs Request for Personal Health Information Form (PDF 1013.58 KB) Published April 17, 2025 Quality Review Request for Personal Health Information (SHA 0417) (PDF 579.1 KB) Published May 9, 2024 Request for Personal Health Information - Risk Management Form (PDF 977.36 KB) Published August 19, 2025 Physician Incomplete Letter Templates 7-Day Physician Deficiency Letter (DOCX 13.48 KB) Published July 10, 2025 Incomplete Documents Letter Template (PDF 999.55 KB) Published May 26, 2025 Registration & Information Services Forms SHA Midwifery Services Newborn Notification (Fillable) (PDF 946.73 KB) Published August 30, 2024 HIM Provincial Fee Schedule Health Information Management Access to Personal Health Information Provincial Fee Schedule (PDF 176.05 KB) Published May 17, 2023 Release of Information - Standard Template Letters Access to Information Template Letter (DOCX 175.23 KB) Published November 12, 2024 Affidavit Production Order Template Letter (DOC 63 KB) Published February 10, 2025 Disclosure of Deceased Personal Health Information After Death (Approved) (DOCX 148.25 KB) Published September 4, 2024 Disclosure of Deceased Personal Health Information After Death (Fully Denied) (DOCX 148.94 KB) Published September 4, 2024 Disclosure of Deceased Personal Health Information After Death (Fully or Partially Denied) (DOCX 163.74 KB) Published December 12, 2024 Disclosure of Deceased Personal Health Information After Death (No Record) (DOCX 148.65 KB) Published September 4, 2024 SHA Release of 3rd Party Information letter template (DOCX 42.15 KB) Published June 14, 2023 SHA Release of Information letter template (DOCX 43.38 KB) Published June 14, 2023 SHA Release of Information letter template - records partially withheld (DOCX 42.86 KB) Published June 14, 2023 Management of Damaged Records Templates Staffing Cost Tracking Sheet (XLSX 17.51 KB) Published February 25, 2025 Verification of Records (Copied) Letter Template (DOCX 47.51 KB) Published February 25, 2025 Verification of Records (Destroyed) Letter Template (DOCX 47.64 KB) Published February 25, 2025 Disclosure to Police Forms The Gunshot and Stab Wound Mandatory Reporting Form (PDF 174.52 KB) Published October 16, 2023
