Health Information Requests
Requests for access to your health records held by Hollywood Private Hospital can be made through contacting the hospital’s Privacy Officer.
If you require access to your health records you may apply by completing the attached Request to access a health record form. Signed photographic identification (such as a photocopy of your driver’s licence or passport) must accompany the application form. Applications will not be processed without the accompanying identification.
If you are requesting health records/information on behalf of a patient, you will need to provide current authorisation in writing from that person allowing you to access their health records/information. Signed photographic identification (such as a photocopy of your driver’s licence or passport) must accompany the application form. Applications will not be processed without accompanying identification and without written authorisation from the patient to release the information to you.
Please note the Privacy Act does not apply for deceased persons. If you are applying for health records/information for a deceased patient, you will need to provide evidence that you are the executor of the will. If more than one executor has been nominated, all parties will need to sign the application form and provide certified ID as applicable. If the patient had not made a will, the court may grant 'Letters of Administration' to an appropriate person who may then make an application for a copy of the health records. All documents provided in support of applications for a deceased person's health records must be certified by an appropriately qualified person.
There may be an administrative charge involved in processing your request and providing access to the requested information. In the interests of providing you with a faster turnaround time and reducing the scope and cost of some applications, please consider if you actually require the entire health record. If you are only after discharge summaries/certain dates/events, we request you apply only for the relevant information. Please nominate the dates on your application form. This will greatly assist in processing your request more cost effectively and in a much shorter time frame.
You will be provided with an estimate of the administrative charge, which is to be paid prior to gaining access to the requested information.
Option 1 – Print Request to Access Health Record Information Form
Please click on the link to produce and print a hard copy of the application form. Please complete and return to the hospital via one of the following methods:
Health Information Services
Hollywood Private Hospital
Locked Bag 202
NEDLANDS WA 6909
Attn: Privacy Officer
(08) 9386 3153
Applications must be accompanied by signed photographic identification. Applications will not be processed without the identification.
Option 2 – Phone
If you have any queries or wish to discuss your application directly, please contact our Privacy Officer during business hours on (08) 9346 6224.
Option 3 – Enquiry
If you have an enquiry related to the release of patient health information, please complete the details below. Fields marked with *are required fields.