Accessing Your Health Records
The Mosaic Primary Care Network (PCN) complies with the Alberta Health Information Act and other related provincial legislation for the collection, use, and disclosure of your health information. We respect and maintain the confidentiality of your health information. The Mosaic PCN Health Records Information Release Specialists and 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.
Due to COVID-19 considerations, mail is the preferred method for returning the completed form at this time. If you must submit the form in person, please contact the clinic in advance to make arrangements and complete a required health screening questionnaire.
How can I get a copy of my health record?
If you are a current or former patient of a Mosaic PCN clinic, you can request your records by submitting a dated, written, and signed (by you and your witness) original request to any one of our Mosaic PCN clinics, using this form: MPCN Consent for Disclosure.
You can submit your request in person or via mail to any one of our Mosaic PCN clinics, or you can mail your request to:
ATTN: Mosaic Primary Care Network – Release of Information
Mosaic Head Office
101 – 807 Manning Road NE
Calgary, AB T2E 7M8
What should the request include?
Please complete the MPCN Consent for Disclosure form. 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 you and another person (witnessed).
Does it cost me anything to request my health record?
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 email@example.com or 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 any one of our Mosaic PCN clinics or the Mosaic PCN Privacy Officer.
How long does it take to process my request?
Requests for health information will be processed within 30 calendar days from the date we receive your request.
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 Mosaic PCN 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, 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.