Your Health Records Page ContentThe Mosaic Primary Care Network in Calgary oversees the collection, storage, retention and access to your personal health record. We respect and maintain the confidentiality of your personal health information. The Health Records Information Release Specialists and Mosaic PCN Privacy Officer manage release-of-information inquiries and requests for copies of your personal health record. The Mosaic Primary Care Network Privacy Officer is available Monday to Friday, 8:00 a.m. to 4:30 p.m. For health records inquiries, please phone 403.250.5059 or email firstname.lastname@example.org. FAQ How can I get a copy of my health record? If you're a current or former patient of a Mosaic PCN clinic, you can request your records by submitting a dated, written and signed original request to any one of our Mosaic Primary Care Network clinics. To release personal health information , please complete this form: MPCN Consent for Disclosure. You may submit your request in person to any one of our Mosaic Primary Care Network clinics, or you can mail your request to: ATTN: Mosaic Primary Care Network - Release of Information Mosaic Head Office101 - 807 Manning Road NECalgary, AB T2E 7M8What should the request include? Requests must include your name, date of birth, mailing address, and the type of information you need. The request must be dated, witnessed and signed by one other person. Does it cost me anything to request medical information? There is an administrative fee associated with the request to view or obtain a photocopy of your health record. The fee for copying varies with the size of the record. Pre-payment of this fee is required prior to accessing your health record. For more information about these fees, please contact the Mosaic PCN Privacy Officer at 403.250.5059. Can I view my health records? Yes, an appointment is required in order to be able to view your record. Please contact the Mosaic PCN Privacy Officer at 403.250.5059. Can I fax or email the authorization for disclosure of health record form? No, because there is an administration fee and we must verify your identification before releasing information with a piece of picture I.D. before a request will be processed. What if I want my records released to someone else? Whether you want your records released to a relative, friend, family doctor, or another institution, you must submit a signed consent giving the hospital authorization to release your information. What if I am inquiring about records for a deceased patient? For patients who are deceased, proof of trustee/executor of the estate, or legal signing authority, must be submitted with your written/signed request. Please note that if you have Power of Attorney for Personal Care for a deceased patient, it expires upon death. How can I obtain records for an incapable/incompetent patient? For patients who are incapable of signing a consent, a proof of legal signing authority must be provided with the written/signed request for patient information. Proof of legal signing authority such as the Substitute Decision Maker may also include the patient’s legal guardian, Power of Attorney for Personal Care, spouse or partner, parent, child, sibling or other relative.