You must complete this consent to indicate your wishes for the future disposition of your embryos if you no longer wish to continue storage of your embryos. Check Cryostorage FAQ for more detailed information.
Patients may request to release their medical chart information from the Regional Fertility Program to send to another clinic or obtain them from another IVF clinic to be sent to the RFP. The RFP adheres to the College of Physicians and Surgeons of Alberta guidelines which state that this process must be completed within 30 days. Medical records are generally kept for 10 years only. Original records will not be sent but will be photocopied at a patient’s request. All release / obtain information consents require a third party witness signature. The fee for this service is a $25.00 administration fee (includes first 20 pages) and 25¢ per page thereafter of photocopying. A pre-authorized credit card form for request of chart copies is also included with the Adobe Acrobat pdf consent form.
Medical records CANNOT be emailed – please indicate whether you would like to have the file faxed, mailed or picked up from our office. When completing the consent please note the following:
♦ If applicable, BOTH partners MUST sign this consent in order for us to release complete information.
♦ The consent MUST be WITNESSED by a separate individual.
Patients who would like to have a language interpreter or support person present are welcome to make these arrangements ahead of time. If you are registered as a couple at the clinic, you will have a joint medical chart with your partner. Sensitive personal information about either partner may be disclosed during your consultation with our physicians. If you choose to use a language interpreter or bring another support person to your clinic visit, both you and your partner will have to provide written consent, for your specific support person to be present as he/she will have access to your joint medical information.