Adopted people and their descendants in Ontario use this application to ask the Custodian of Adoption Information to locate birth relatives when medical information could significantly improve the diagnosis or treatment of a severe mental or physical illness. The search can obtain information, share it, or both. Part D, the health care professional questionnaire, supplies the medical justification the custodian relies on to decide eligibility.
The applicant completes Parts A to C and F, plus Part E consent from an adoptive parent or guardian if under 18. A physician or other regulated health care professional completes Part D after the patient signs its consent to disclose health information.
Download the current version from the source each time; forms change without notice.
Adopted Person's and Descendant of Adopted Person's Application to Request a Severe Medical Search
Demande de recherche présentée par une personne adoptée ou l'un de ses descendants en raison de graves problèmes de santé
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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A physician or other regulated health care professional. The form offers CPSO member, FRCP or FRCS, registered psychologist, nurse in the extended category, or another regulated designation you describe. The guide asks you to verify the nature, severity and urgency of the situation.
Yes. The ministry's forms site posts a French edition, 3090F, titled Demande de recherche présentée par une personne adoptée ou l'un de ses descendants en raison de graves problèmes de santé, along with PDF, Word and accessible HTML versions of the form and its guide.
Yes, in limited cases. When a deceased adopted person suffered from a severe mental or physical illness, a CPSO member, a member of the College of Psychologists, a nurse in the extended class, or a practitioner authorized outside Ontario may apply, as may the spouse or executor.