Access to Information

Use the request access to information form to

Request access to general records ($5.00 fee required).
Request access to your own personal health information.
Request a correction to your own personal health information.
Request a correction to your own personal information.

Note: A $5.00 application fee is required for all requests for access to general records under the Municipal Freedom of Information and Protection of Privacy Act.

Comments

This field is for validation purposes and should be left unchanged.

Type of request

Select one(Required)

Access to general records ($5.00 fee required)

Access to own personal health information

Correction to own personal health information

Correction to own personal information

Your information

Name

First Last

Address(Required)

Street Address City Province Postal code

Phone (daytime)(Required)

Phone (evening)

Details of your request

Please describe the records you are requesting or the information you would like to be corrected. We will provide you with access to your personal health record, unless a legal exemption applies.

Description(Required)

Note: If you are requesting a correction of information, please:

Describe the correction(s) you are requesting.

If we do not make the correction, we will notify you. You may request that a statement of disagreement be attached to your record. By typing your name below, you consent to the use of your electronic signature and confirm that the information provided is accurate to the best of your knowledge.

Signature (first name, last name)(Required)

The personal information contained on this form is being collected in order to process your access to information request in compliance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 and the Personal Health Information Protection Act, 2004, S.O. 2004. This information will be used to process the request for information and if necessary to complete statistical reporting required by the Information and Privacy Commission of Ontario. Questions about this collection should be directed to the Privacy Officer at Public Health Sudbury & Districts, 1300 Paris Street, Sudbury, ON, P3E 3A3, 705.522.9200 or by email at privacy@phsd.ca