Ah 216 2026

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The document is an authorization form allowing a user or an authorized person to permit a healthcare establishment to share specific information from the user's file for services received during a designated period. It includes personal details such as names, addresses, and dates, and requires signatures from the user or authorized individual and a witness.

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Click ‘Get Form’ to open the ah 216 in the editor.
Begin by entering your full name at birth in the designated field, followed by your current name. This ensures that all records are accurately matched.
Fill in your current address and the file number (N° de dossier) along with your RAMQ number. These details are crucial for identification purposes.
Provide your date of birth by selecting the year, month, and day from the dropdown menus.
Next, enter the names of your parents as required. This section helps establish familial connections relevant to the authorization.
Indicate any other names you have previously used, if applicable. This is important for comprehensive record keeping.
In the authorization section, specify who is granting permission (yourself or an authorized person) and their role.
Finally, sign and date the form where indicated. Ensure a witness is present to validate your signature if necessary.

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