​Patient Removal Request Form
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​Process to request removal of physician from patient admission/registration

Process to request removal of physician from patient admission/registration and report misdirected records belonging to Interior Health. If you received misdirected records from another public body, do not complete this form and send your correction request to the owner of those records.

An accurate patient record is critical to ensuring timely and appropriate health care. When physicians move or retire, patients change health care providers, or data entry errors occur, this may result in records being misdirected. This encrypted online form allows physicians and healthcare professionals to securely report and quickly correct this matter.

Any related or misdirected records MUST be attached with your request specific to each patient. These records contain information needed to ensure the correct departments are notified of your request and without them there is no guarantee the issue can be completely fixed.

Please keep these records in a safe place for 3 business days, in case we need you to resend them. After such time, destroy the records by secure shredding.

Note: If the patient presents again and identifies the same physician as their health care provider, you will need to submit another removal request and contact the patient to advise them that you are not their physician.


This form is intended to be used solely for official purposes by authorized personnel.  Unauthorized access or use may subject violators to criminal, civil and administrative actions.


MoH     PCQO