The Right to Access Medical Records

Medical records contain sensitive personal information about a patient. That’s why not just anyone is allowed to see them. 

General rule: confidentiality 

As a general rule, medical records of patients are confidential. Only patients can see them. No one else can see them without a patient’s permission, or the permission of a person allowed to make this kind of decision for the patient (for example, a parent ou tutor).

However, this rule regarding confidentiality is not absolute. These exceptions are found in the law, and they allow other people to see the medical records of patients without their permission. 

Note that anyone who gets the right to see medical records can ask the health care institution or private clinic for help understanding what they say. Let’s see what the right to see medical records means. 

Patients 14 years old or older 

As a general rule, patients who are 14 years or older have a right to see their medical records. At this age (14 years), minors are also allowed to give their own consent to medical care. 

If the parents, or the people with parental authority, wish to consult the medical records, the healthcare institution will first ask for the minor’s opinion. The parents will be denied access if the institution believes it could be harmful to the child’s health or safety to see the records.  

When their child turns 18 years old, parents no longer have the right to consult their child’s medical records.  

The law allows a few situations in which other people can see the medical records of a minor without their child’s consent (see below). 

Patients under 14 

Children under the age of 14 are not allowed to read their own medical records except by going to court with the assistance of their lawyer. But this rule is not meant to stop children from talking openly with their health care professionals.

Usually, it is the parents of these children, or the persons with parental authority, who have access to the medical records.

Representatives of adult patients 

Adults who have a health condition that prevents them from taking care of themselves or their finances can be declared incapable by a court. Another person is then appointed to represent them and act in their best interests. The representative is called a tutor or mandatary.

For patients who are unable to make health care decisions on their own, their tutor or mandatary decides for them.

Patients who can’t given their consent to medical care but have not been declared incapable are represented by their spouse or a close family member or friend, or a person who shows a particular interest towards them.

The representative of the patient is allowed to see information in the patient’s medical records, but only if this is necessary to make health care decisions on behalf of the patient. 

Heirs and family of a deceased patient 

If a patient dies, the heirs (people entitled to inherit) and family have access to the information in the patient’s medical records, but only under certain conditions. Access to the records is limited to necessary information. 

Heirs

The heirs must clearly explain why they need access to the patient’s medical records to exercise their rights as heirs. For example, heirs can get access to the medical records by proving they plan to take a legal action or file a complaint against the health care institution.

Then the institution will evaluate the request for access. 

Important! Heirs must prove that they are in fact heirs by providing a copy of the will and other documents needed for the request to access medical records. 

Family 

The spouse and immediate family of a patient who has died are only allowed to see information that could help them in their grieving process. However, they cannot see this information if the patient provided a written refusal in advance. 

Blood relatives of the deceased patient can have access to the information in the medical records to verify the existence of a specific genetic or inherited illness. In this type of situation, the patient’s advance written refusal does not apply. 

When asking for access to medical records, relatives must specifically identify the illness they want to know about. Also, the request for access must provide details and explain the reasons why they need access.

Other people, with the patient’s consent

Patients can give anyone permission to see their medical records. Permission can be for the entire medical record or for a specific section. 

Permission given by patients for other people to consult their medical records for study, teaching or research purposes must be given in writing and is valid only for the duration of the activity or research. 

Other people, without the patient’s consent 

There are some exceptions to the rule of confidentiality of medical records. Some laws describe situations in which certain people can access the information in patients’ records without their consent. Here are some examples:

• To prevent an act of violence, including suicide, when there is a real and urgent risk of death or serious injury to a person or group of people that can be identified.
• For study, purposes of a research project (In specific cases, the director of professional services or director general of the health care institution can authorize a professional to consult the medical records for these reasons. The authorized professional must respect the confidential nature of the information). 

Other laws provide that patients’ medical information can be given without their permission to certain organizations in specific situations. Examples include the Commission des normes, de l’équité, de la santé et de la sécurité du travail (labour standards, pay equity and workplace health and safety board) and the Commission des droits de la personne et des droits de la jeunesse (Quebec human rights commission), and the Director of Youth Protection (DYP).

Employers

Employers do not have access to their employees’ medical records. 

However, employers are allowed to know about important medical information in specific situations:

• If an employee is absent from work for many days due to illness, the employer can ask for a medical certificate explaining the absence. 
• If the employer has reason to believe the employee is not physically able to do the work required, the employee can be asked to have a medical examination. The employer will then be allowed to read the medical report prepared by the expert who met with the employee. 

Employers are not allowed to ask for a copy of a future employee’s medical records during the hiring process. But the employer can evaluate the candidate’s physical and psychological abilities to do the job by asking questions or by asking the employee to have a medical evaluation. In this case, the employer has access to the expert’s report.

The person who is responsible for employees and for decisions that concern them (for example, the director of personnel) is the only one allowed to access an employee’s medical information.