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Adobe PDF   Restricting Access to Information in the Ontario Laboratories Information System (OLIS) Withdrawal of ConsentThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print118.0 kb

Form Classification
Classification / Identification:
 Form Number:014-4471-44EEdition date: 2013/08 
 Title:Restricting Access to Patient Records In theOntario Laboratories Information System
 Ministry:Health and Long-Term Care  
 Branch/ABC:Laboratory Services  
 Program:Ontario Laboratory Information System (OLIS)  
 Purpose of Form:Complete this form if you wish to have the Ministry of Health and Long-Term Care restrict access to your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.   

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