NSHA Authorization For Release Of Personal Health Information form

AUTHORIZATION FOR RELEASE OF PERSONAL HEALTH INFORMATION. This form is to give consent to the Nova Scotia Health Authority (NSHA) releasing the personal health information described in Section 3 (the "Records") to myself/the Recipient listed in Section 2. I am personally responsible to pay any fees associated with the release, and fees may be payable in advance of any access. Last updated August 16, 2019.
PDF icon NSHA Authorization For Release Of Personal Health Information form