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Click here to download a Consent to Disclose Personal Health Information form
The following fees apply when requesting the release of information:
Release of Information Schedule of Fees
Central East LHIN
Third Party Requests
| Basic Search Fee (No patient records found) |
$150.00 |
| Law Firms/Insurance Companies/Rehab Consultants |
$200.00 (first 25 pages) |
| thereafter |
$1.00 per page |
| Criminal Injuries Comp. Board |
100.00 |
| Solicitor General/Attorney General |
$200.00 (first 25 pages) |
| thereafter |
$1.00 per page |
| Legal Aid |
$200.00 |
| Public Guardian |
$0.50 per page |
| College of Physicians and Surgeons / College of Nurses |
$0.25 per page |
| WSIB / Appeals Tribunal |
$48.15 |
| Hourly Rate for Court Attendance |
Standard witness fee |
Patient Requests
| Patients |
$100.00 (1-25 pages) + |
| thereafter |
$1.00 per page |
| Time of Birth |
$100.00 |
| Proof of Birth |
$50.00 |
| Visit History / Confirmation of Visit |
$15.00 |
| Hospital / Physician for patient care |
No charge |
| Chart viewing with HIM staff |
$50.00 per ½ hour or portion thereof |
Research Fees
| Administration Fee |
$50.00 |
| Charts pulled/viewed |
$5.00 per chart |
| Copies |
$1.00 per page |
| Charts requested from Outside Storage |
As charged by vendor |
| Microfilm In-service |
$25.00 flat fee |
| Viewing |
$5.00 per chart |
| Copies |
$1.00 per page |
| Electronic Access |
$25.00 |
Miscellaneous
| CD ROM for diagnostic imaging tests |
$10.00 |
| Rush Fee (within 72 hours, in addition to fee schedule) |
$200.00 |
| Courier Costs |
Requestor responsibility |
July 2006 - Discretion (in whether or not to charge in the above cases) may be used depending on the circumstances for which the information is required.
Click here to download this information in pdf.
Please click here to download a Consent to Disclose Personal Health Information form. The form must be completed and faxed to the Health Records office at 705-328-6156.
Click here for a complete list of Programs & Services offered at Ross Memorial Hospital
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