The Huron Perth Healthcare Alliance staff and members of the general public may make formal or informal requests for information in the custody or control of the Hospital.
The types of Records that the Huron Perth Healthcare Alliance holds in its custody and control can be viewed by clicking INVENTORY - General Records / Personal Information Bank
Should you wish to make a formal request under FIPPA, review the instructions and complete the form below - form can be printed and mailed.
for Completing Access or Correction Request
Access to Records
Many records of hospital institutions are
available to you without making a request under the Freedom of Information and
Protection of Privacy Act (FIPPA). Contact the Information and Privacy Office
of the Huron Perth Healthcare Alliance that holds the records to determine
whether you need to make a formal request.
Type of Request
Check the box that indicates what you are
requesting (Records that do not contain personal information are general
records) The FOI Coordinator is required to verify your identity before giving
you access to your own personal information. If you are requesting another
person’s personal information records, you must provide proof that you have the
authority to act for them (e.g., power of attorney, guardian or trusteeship
Please ensure you have entered your name,
address and telephone numbers accurately.
Description of Records or Correction Requested
Provide as much detail as possible about the requested general records, own
personal information, other’s personal information or correction of own
personal information. Use a separate sheet of paper if you need more space and
attach it to this form. If you are requesting personal information records,
provide the name that should appear on them.
Specify the time period for the records as
precisely as possible, e.g., from 2008/07/21 to 2009/11/30.
If you are requesting a correction of your
own personal information records, describe the correction you want and provide
any supporting documents. If possible, provide copies of the information to be
corrected and the information you wish to have it replaced with. Check a box
to indicate whether you want to examine original documents (which may only be
done on site) or receive copies.
Payment and Signature
Information & Privacy Office Huron Perth Healthcare
Alliance Stratford General Hospital Site 46 General Hospital drive Stratford,
ON N5A 2Y6 519-272-8210 Ext. 2736 Room W1-217 (First Floor West Building
A $5 application fee is required. Cash payments must be made in person. Make
cheques/money orders payable to the Huron Perth Healthcare Alliance. Sign and
date the form and mail it or submit it in person to:
FREEDOM OF INFORMATION (FOI) Request Form: