Medical records contain sensitive personal information about a person. 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, tutor or curator).
There are a few exceptions to these rules. 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.
Important! In some situations, patients can be refused access to their own medical records.
Patients must give permission for other people to see their medical records.
For example, children 14 years old or older can refuse to let their parents see their medical records. Parents will not be allowed to see the child’s records if the child refuses and the healthcare institution decides it could be harmful to the child’s health for the parents to see the records.
However, the law creates a few situations in which other people can see this child’s medical records without the child’s consent (see below).
Patients Under 14
Children under the age of 14 are not allowed to read their own medical records. 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 who have access to the medical records.
Parents of a Child Under 18
The parents of a child under 18 or the people with parental authority have the right to access their child’s medical records.
Also, after a child turns 18, the parents no longer have the right to access the child’s medical records.
Representatives of Adult Patients
Adults who have a health condition that prevents them from taking care of themselves or their property 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, curator or mandatary.
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.
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 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.
The spouse and immediate family of a patient who has died are only allowed to see information about the patient’s cause of death. 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, teaching or research purposes (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.)
- if a patient is transferred (The institution transferring the patient must send the other institution a summary of the information it will need to take over the patient’s case.)
- following an order of a court or a coroner
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 (CNESST, the board that deals with workers’ compensation) and the Commission des droits de la personne et des droits de la jeunesse (Quebec human rights commission) or Director of Youth Protection (DYP).
The reason for these exceptions is to protect the individual and society, and for quality control.
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.
Important! If access to a medical record is refused, a request for review of the decision can be made. Only the documents submitted with the first request for access will be considered. So it’s best to make the first request as detailed as possible and include the necessary documents.