Proxy Access Forms

Proxy Access is designed to allow you to give another person access to your personal health information (myCAREmedical record) at GHC. 

Before you can connect another person to your myCARE medical record, you must first complete a Proxy AccessRequest Form and return it to the Group Health Centre to request access. Proxy Access is available at your PrimaryCare Provider's discretion, and can be revoked at any time by the patient or the Primary Care Provider (eg. FamilyDoctor/NP). 

There are two Proxy Access Request Forms - based on the age of the patient whose records will be accessed. Click on the appropriate form to download a copy:

Proxy Access to records of a patient <12 years old 

Proxy Access to the records of a patient 16+ years old (Adult) 

Please note: Proxy Access is not currently available to patients between the ages of 12 and 15 years old.

Completed Proxy Access Request Forms can be submitted at the front registration desk at the Group Health Centre(240 McNabb St). Your primary care provider must approve all Proxy Access Forms prior to granting Proxy Access.