What is a substitute decision maker?

The term “substitute decision-maker” generally refers to a person who is authorized to consent on behalf of an individual to the collection, use or disclosure of personal health information about the individual.

How do you prove that you are authorized?

Personal health information is extremely sensitive and it's important that only authorized individuals can access any individuals data. Appropriate SDM documentation ensures that a health information custodian is certain that you have the authority to access an individuals personal health information.

Without sufficient documentation, health information custodians can and will reject records requests because they can't be certain you have a legal right to access someone else's health information.

When is a SDM required?

There are a few cases in which a substitute decision maker is needed to complete a request:

- the patient is considered to be incapable of providing consent;
- the patient is a minor;
- the patient is deceased.

Parent or guardian SDM documentation:

If you are a parent or the legal guardian of the patient please provide the following documentation to ensure your request is processed as smoothly as possible.

‍Valid documents include:

- Long form birth certificate
‍
OR
‍
- Court documents appointing the signer as guardian

Power of attorney SDM documentation:

‍If you are have been appointed a power of attorney for the patient please provide the following documentation to ensure your request is processed as smoothly as possible.

‍Valid documents include:

- Original power of attorney document

OR
‍
- Court documents appointing you as a Guardian

Executor of estate documentation:

‍If you are have been appointed an executor for the patient please provide the following documentation to ensure your request is processed as smoothly as possible.

‍Valid documents include:

- Original will

OR
‍
- Certificate of appointment of estate trustee

What are informal substitute decision makers?

In some situations there is no formal designation of a substitute decision maker. It is up to the discretion of the health information custodian to asses any provided documentation and determine whether they are able to release records.

Here is the rank order of informal substitute decision makers:

1. Guardian (if the guardian has the authority to make such decisions);

2. Attorney for personal care or attorney for property (if the attorney has the authority to make such decisions);

3. Representative (appointed by the Consent and Capacity Board under the Health Care Consent Act, 1996 if the representative has the authority to give the consent);

4. Spouse or partner;

5. Child’s custodial parent, or children’s aid society or other person legally entitled to give or withhold consent in place of a parent;

Note: where this is the situation, the child’s parent cannot consent on behalf of the child;

6. Parent with access rights;

7. Brother or sister, and;

8. Any other relative (related by blood, marriage or adoption).

If you have any questions regarding substitute decision makers, the documentation required and/or the policies of the provider you are requesting from please contact their staff for more information.