Protecting Your Privacy

Protecting your privacy is important. PSFDH promises to ensure that your confidential information is kept secure and used only for the purposes stated in accordance with the Public Hospitals Act. Release of any information follows all legislative requirements. If you have any questions or concerns regarding your health record you may contact Health Records department at each site:

  • GWM Site (Perth)
    613-267-1500 ext. 1149
  • Smiths Falls
    613-283-2330 ext. 1149

Collection of Personal Information

We collect personal health information about you directly from you or from the person acting on your behalf. The personal health information that we collect may include your name, date of birth, address, health history, records of your visits to the PSFDH and the care that you received during those visits. Occasionally, we collect personal health information about you from other sources if we have obtained your consent to do so or if the law permits.


We use and disclose your personal health information to:

  • treat and care for you
  • get payment for your treatment and care (from OHIP, WSIB, your private insurer or others)
  • plan, administer and manage our internal operations
  • conduct risk management activities
  • conduct quality improvement activities (such as patient satisfaction surveys)
  • teach
  • conduct research
  • compile statistics
  • comply with legal and regulatory requirements; and
  • fulfill other purposes permitted or required by law.

Your Choice

If you think your personal health record is not correct or complete for your purposes, you may request (in writing) to correct the record. This written request should be sent to the Privacy Officer. Patients may withdraw their consent for some of the uses and disclosures listed above by contacting us (subject to legal exceptions) at


Accessing Your Health Care Information

  • Informal Process
  • We make information available to the public on a routine basis under public reporting on our website.  No formal request under FIPPA is required for information released on a routine basis.
  • Formal Process to Request Information under FIPPA

Access to a range of recorded information held by PSFDH is provided for under the Freedom of Information and Protection of Privacy Act (FIPPA). This includes records of personal information in the custody or control of the hospital from January 1, 2007, subject to certain exemptions and exclusions. The Act does not apply to personal health information which is subject to the provincial Personal Health Information Protection Act (PHIPA).


The Act has two main purposes:

  • to make public bodies more transparent and accountable by providing individuals with the right access to government records.
  • to protect personal information from unauthorized collection, use or disclosure.

A request for information in the custody or control of the hospital can be made under the Freedom of Information and Protection of Privacy Act (FIPPA). You may also request access to view or change your personal information.


How To Make a FIPPA Request

Access requests can be made for general records, personal information or correction to your own personal information. These requests must be made in writing to the Health Records Department at either site. We recommend reviewing your record with a clinician and we can assist in arranging that. You can also request a photocopy of your chart.


Please note: Email requests will not be accepted.

  1. To request access to general records, check the Directory of Records to determine whether PSFDH maintains the information you need.
  2. To request a correction to your own personal information, check the list of Personal Information Banks held by PSFDH and be as specific as possible about the location of the personal information to be corrected. Documentary proof may be required to support the request.  A formal request under FIPPA is not intended to replace the process for routinely updating personal information to reflect things such as address changes. Those types of changes should be made informally by contacting the appropriate department or program.
  3. Complete and print the PSFDH Access/Correction Request Form (print only). You must clearly identify the records you are seeking. This will minimize the search time and ensure an accurate response. Be sure to include your contact information.
  4. Payment of $5 is to be submitted with request.  If providing a cheque or money order, make it payable to “Perth and Smiths Falls District Hospital “.  Cash is also accepted.
  5. Submit your request, including your contact information and a non-refundable $5 application fee to:
    Perth and Smiths Falls District Hospital
    Attention:  Privacy & Access to Information Officer
    60 Cornelia Street West
    Smiths Falls, ON
    K7A 2H9

Once we have received your application and $5 application fee, we will send a written acknowledgement of your request. There is a cost recovery fee for these requests. Please allow a minimum of 24 hours for us to process your access request and one to two weeks to process a request for photocopies.

For More Information

Resource Materials

Directory of Record and Personal Information Bank

Access/Correction Request Form (print only)

Fee Schedule


Links to the Act, and other related information, including answers to Frequently Asked Questions related to FIPPA, are provided below.