Medical Records

Help a child. Donate.

Book your first appointment

"*" indicates required fields

Name of doctor who referred you

Department you are being referred to (if known)

Attach a referral*

Accepted file types: jpg, png, pdf, doc, jpeg, Max. file size: 2 MB.

Please make sure that your attachment is clear and legible. We do not process incomplete applications or provide appointments without a copy of the referral. If you do not attach your referral, you will need to fax it to the department directly. Wait times depend on the priority assigned to the referral and can be as long as several months.

Patient Information

Child's last name*

Child's first name*

Date of birth*

MCH Medical record number (if known)

Health insurance card number*

Health insurance card expiration date*

'DD' corresponds to the child's date of birth.

Address*

Select your province or territory*

City*

Postal code*

Contact Information (for parent or guardian)

Your first name*

Your last name*

Your relationship to patient*

Email address

Phone number*

Alternate phone number

Comments

CAPTCHA

Medical Records

Request a medical file

The medical record is a confidential document kept in the medical records department. Medical archivists ensure the disclosure of health information in accordance with the laws and regulations in force in Quebec.

In accordance with article 17 of the Act respecting health and social services information, every person has the right to be informed of the existence of and to have access to any information concerning him or her that is held by a body.

Request a medical file

To obtain a copy of your child’s medical record, please complete the attached form and send it by mail, fax or email to [email protected]. You can also complete the form in person at one of our offices, during normal business hours.

We can send you the requested information by email (maximum of 30 pages). Please, always indicate an alternative means of transmission, such as pick-up on site, mail or fax, in case email transmission is not possible.

Who can sign the request?

For patients under 14 years of age: the parent or legal guardian
For patients 14 years and over: the patient, legal guardian or mandatary

Please include the following information in your request so that we can respond appropriately:

patient’s first and last name
date of birth
patient’s hospital card number according to the site
health insurance card number
your complete contact information (name, address, telephone number)
specify the information required and the period covered
last name and first name of the recipient
address of the recipient
date and signature of the user or authorized person

To avoid further delays in processing your request, please ensure:

You have signed your request by hand, with a stylus or via a Document Signing Software, such as DocuSign.
You have correctly indicated the name of the hospital or hospitals from which you wish to receive information in the “Establishment” section of the form.

For more information, visit the Access to Information Office of the MUHC page.

This page needs an update? Report it here!