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Alberta health services personal information form 2026

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The document is a Health Information Access Request form used to request health information for oneself or another individual. It outlines the submission process, required identification, associated fees, and details needed for the request. The form includes sections for patient and requester information, types of records requested, and options for receiving the information. Additionally, it specifies conditions under which someone can request information on behalf of another person.

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Click ‘Get Form’ to open the alberta health services personal information form in the editor.
Begin by identifying who is requesting the information. If you are the patient, complete page 1. If you are not, fill out both pages 1 and 2.
In the 'Patient Information' section, enter the patient's last name, first name, date of birth, and personal health number.
For 'Requester Information', provide your last name (or check 'Same as above'), mailing address, email address, phone number, and signature.
Specify what information you want by checking the appropriate boxes for records such as discharge summaries or test results. Include details about treatment sites if applicable.
Indicate how you would like to receive this information—either in person or by mail—and provide any necessary addresses.
If requesting on behalf of someone else, complete page 2 with your relationship to the patient and reason for disclosure.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is my Alberta health care number?

Please call the Alberta Health Care Insurance Plan Contact Centre at 780-427-1432 for assistance (Dial 310-0000 first for toll-free calling within Alberta). What to do: Call the Alberta Health Care Insurance Plan (AHCIP) Contact Centre at 780-427-1432.

What is Alberta health care called?

Alberta Health Services (AHS) is the single health authority for the Canadian province of Alberta and the largest integrated provincial health care system in Canada. Headquartered in Edmonton, AHS delivers medical care on behalf of the Government of Albertas Ministry of Health.

Is phn the same as Alberta health care number?

Before we jump into how to check for non-Alberta government coverage, its important to understand healthcare numbers for patients. Every patient in Alberta is given a Unique Lifetime Identifier (ULI) number. If they have Alberta Health coverage, this ULI number is the same as their Personal Healthcare Number (PHN).

What is a phn number in Alberta?

An identifier, such as a Personal Health Number (PHN)/Unique Lifetime Identifier (ULI), Medical Record Number (MRN), or federal identifier. Users with a limited patient search user role can only search by identifier.

What is consent to disclose personal information in Alberta?

A person can consent to the collection, use or disclosure of personal information for reasonable purposes (which is what a reasonable person would consider appropriate under the circumstances). Someone may consent verbally or in writing, including via electronic communications.

alberta health information access request form

Alberta Health information Access request form Consent to disclose health information Alberta Release of information form Alberta AHS Access and Disclosure phone number How to get medical records Alberta Access and Disclosure AHS Consent to disclose personal health information form Alberta health information Act

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Is MRN the same as Alberta Health number?

MRN (Medical Record Number) - Provincial identifier (assigned by Connect Care for Alberta Health Services [AHS]) ULI (Unique Lifetime Identifier) - Provincial identifier (assigned by Alberta Health for medical services), often needed for seeking patient information in other provincial systems (e.g., Netcare)

What documents do I need for Alberta health care?

Identity documents include: passport. permanent resident card (both sides) certificate of Indian Status issued by the Federal Government. government issued drivers license. government issued registries ID card. Canadian citizenship card.

How do I update my Alberta health?

Update your information Complete the form. Fill out the form that applies to you: Update or replace AHCIP Notice of Change UPDATE Change name, address, date of birth, gender, or replace a card. Submit your form. Take your completed form to a participating registry or send it to the AHCIP office.