To access your chart, you must be 14 years or older and send a request, written in pen, containing the following information:

• Your full name.
• Your complete address and a daytime phone number. Please indicate if a message can be left or not.
• Your date of birth.
• The full name of both your mother and father.
• Please specify which documents you want (psychiatric and/or professional evaluation, hospitalization summary, etc.) and the date of these documents.
• Please specify to whom the documents are to be sent. If this person is a health professional, his or her name as well as the name and complete address of the establishment where the documents are to be sent are required.
• Your request must be signed and dated.

Please send your request to the Medical Records Department, Correspondence Sector, Douglas Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3.
 

Only your treating physician can fill out and sign the form.

• Keep your medical chart confidential and deny access to it to anyone who does not have your consent. Consequently, no personal information is given over the phone, by fax or by e-mail.
• Process your request within 20 days of its receipt. (If necessary, the law permits an additional 10 day delay). The documents will be mailed to you. If you prefer to pick them up in person, you must have an identification card with a picture and a specimen of your handwriting (health insurance card, driver’s license).
• Advise you in advance if there is an applicable fee for the release of the requested information.
• If the doctor refuses you access to your medical record because of your health condition, he or she must justify the refusal and determine when you will be able to request access again. We will then advise you of this date as soon as possible.