Consent to Disclose Health Information Form - Alberta Health 2026

1. Click ‘Get Form’ to open the Consent to Disclose Health Information Form in the editor.
2. Begin by entering the patient's/client's name, birthdate, and personal health number (PHN#) in the designated fields. Ensure accuracy as this information is crucial for identification.
3. In the 'Details of health information being disclosed' section, provide a comprehensive description of the health information, including specific dates of treatment without using abbreviations.
4. Identify where records exist by selecting the appropriate health service provider, hospital, clinic, or program. Fill in the city/town associated with these records.
5. Specify the effective date of consent and an expiry date if applicable. If no expiry date is provided, it will be valid for two years.
6. List the individual(s) or organization(s) to whom the information is being disclosed along with their contact details.
7. Indicate the purpose(s) of disclosure and specify your authority if signing on behalf of someone else. Attach any necessary documentation that supports your authority.
8. Finally, review all entered information for accuracy before signing and dating the form at the bottom. This confirms your understanding and consent regarding the disclosure.

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