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Blood Donor Clinic - Mitchell
5 p.m. to 8 p.m. / Mitchell Arena and Community Centre
19/08/2020
Blood Donor Clinic - Goderich
1 p.m. to 7 p.m. / Goderich YMCA
Men have more blood than women. Men have 1.5 gallons versus 0.875 gallons for women.
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Accessibility

Freedom of Information (FOI) Requests

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.

Instructions for Completing Access or Correction Request

Informal 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.

A. 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 order).

B. Requester’s Information
Please ensure you have entered your name, address and telephone numbers accurately.

C. 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.

D. Payment and Signature
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:

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 Administration Wing)

FREEDOM OF INFORMATION (FOI) Request Form:




Access to Information and/or Correction to Personal Information REQUEST FORM: (Under the Freedom of Information & Protection of Privacy Act-FIPPA)
 
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* Type of Request (Check only one):
 
 Access to General Records
 Access to own Personal Information
 Correction of own Personal Information

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* Last Name:
 
1 1
* First Name:
 
1 1
Middle Initial:
 
1
* Address:
 
1 1
City/Town:
 
1
Province
 
1
Postal Code:
 
1
Telephone #(s)
 
1
Email:
 
1
 
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If request is for access to, or correction of, own personal information records:
 
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Last name appearing on records
 
2
 
1
 
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Detailed description of requested records, personal information or personal information to be corrected: (If you are requesting access to or correction of your personal information, please identify the record containing the personal information, if known).
 
7
 
1
Note: if you are requesting a correction of personal information, please state the desired correction and, if appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may require that a statement of disagreement be attached to your personal information
 
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1
 
7
Time Period of the Records
 
1
 
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Preferred Method of Access to Records
 
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 Examine Original
 Receive copy

3
 
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Signature of Requester
 
7
 
1
 
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$5 Application Fee Enclosed:
 
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 Yes
 No

3
Date:
 
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Personal Information contained on this form is collected pursuant to the Freedom of Information and Protection of Privacy Act (FIPPA) and will be used for the purpose of responding to your request. Questions about this collection should be directed to the Information & Privacy Office of the Huron Perth Healthcare Alliance 519-272-8210 Ext. 2736
 
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