CLOUD PHARMACY LEGAL RECORDS BUREAU

Records Request

Self-serve patient record requests for legal counsel. PHIPA-compliant. 48-hour rush available.

1 · LAW FIRM INFORMATION

Firm name

Firm address

Firm email (receipt goes here)

Phone

Contact person (you)

2 · PATIENT INFORMATION

Patient name

Date of birth

Health card (optional)

Other information (optional)

3 · RECORDS PERIOD

From

≈ 1 year × $25 = $25.00 for records portion

4 · TURNAROUND

5 · WHERE TO SEND RECORDS

Email address

Cloud Pharmacy will deliver the records to this address. Often the same as your firm email.

6 · FORMAL REQUEST

Upload your signed authorization, subpoena, or court order. PDF only, max 10 MB.

Drag & drop signed PDF, or click to browse

7 · PHIPA & CONFIDENTIALITY

Cloud Pharmacy releases records under PHIPA s.41 with documented patient consent, court order, or subpoena. All requests are audited.

I attest that I have appropriate legal authority (consent, subpoena, or court order) for this request.I acknowledge the confidentiality terms — records are released only to the email address I provided.