Form for requesting the medical records of a deceased patient

A request for the medical records of a deceased patient can only be processed after receiving a release from the professional secrecy to which all health professionals are subject. The authority in charge of releasing professional secrecy is the Cantonal Physician. Therefore, in these cases your request must be accompanied by a written and signed justification and, if available, the document (Family Status) attesting to the relationship with the patient.

We inform you as of now, that in case of refusal of the release of professional secrecy by the Cantonal Physician, we will not be allowed to hand over the documentation to you.

* Required fields

* Patient name

* Patient's last name

* Patient's date of birth

* Date of death of the patient

* Name of applicant

* Applicant's last name

* Date of birth of the applicant

* Telephone number of the applicant

* Degree of kinship

* Upload the applicant's ID

Upload only PDF documents, maximum 7 MB

* I request copies of medical records related to

Outpatient visit Inpatient

* Indicate the date of the visit/inpatient stay

Indicate any additional date of the visit/inpatient stay

* Location(s) where the visit/degree occurred

(multiple options possible)

Ospedale Regionale di Bellinzona, San Giovanni Ospedale Regionale di Bellinzona, Acquarossa Ospedale Regionale di Bellinzona, Faido Ospedale Regionale di Lugano, Civico Ospedale Regionale di Lugano, Italiano Ospedale Regionale di Locarno, La Carità Ospedale Regionale di Mendrisio, Beata Vergine Clinica di Riabilitazione EOC, Faido Clinica di Riabilitazione EOC, Novaggio Istituto Cardiocentro Ticino

If known, give the name of the EOC Service or more details related to your request (e.g. name of doctor, department...)

* For each of the indicated treatment periods I wish to receive

(only one possible option)

Type 1 request (cost-free) - one or more specific documents Type 2 request (cost-free) - the clinical and para-clinical elements of the medical record Type 3 request (subject to possible cost) - all medical and nursing documentation Request one or more specific documents, (e.g., an electrocardiogram or discharge letter). Indicate precisely in the field below the information needed to best identify the documents. It includes a complete collection of key information about the care pathway, such as discharge reports, visits, examinations, etc. All documents for this type of request are also readily available by downloading the "Insieme EOC" application. Apply only as needed: allows access to the entire care pathway. May incur a cost of up to CHF 300 for complex administrative work.

* Delivery details

(only one possible option)

I authorize sending in paper format by registered mail / A+ I authorize sending in electronic format to the following e-mail address I will personally, after telephone contact, pick up the documentation I authorize the following person to pick up, after telephone contact, the documentation at one of the EOC locations

* Address to receive paper documentation

* Email to receive electronic documentation

* Upload signed document explaining in detail the reasons for your request

Upload only PDF documents, maximum 7 MB

If available, upload the family status certificate attesting to your relationship with the patient

Upload only PDF documents, maximum 7 MB

* Protection of personal data

I declare that I have read, understood, and accept the information contained in the EOC Data Protection Statement.
I agree that my personal data, including health-related and other data worthy of special protection under Article 5 of the Federal Data Protection Act (DPA), will be processed and stored in accordance with this Declaration and the applicable data protection regulations in Switzerland.

By submitting this form, I declare that the information and documents provided are true. I am aware that in case of false statements or forged documents, I may incur penalties under the Swiss law

Disclosure

Data Protection

EOC processes users' personal data in accordance with the Data Protection Law of the Canton of Ticino ("LPDP", RL 1.6.1.1.) and its Implementing Regulations. Click here to view our data protection notice.

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Form for requesting the medical records of a deceased patient

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Form for requesting the medical records of a deceased patient

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