HIA Notification Statement


Health Information Act section 22(3) states that when collecting individually identifying health information directly from the individual it is about, the custodian must take reasonable steps to inform the individual about:

• the purpose for which the information is collected;
• the specific legal authority for the collection; and
• the title, business address and business telephone number of an affiliate of the custodian who can answer the individual’s questions about the collection.

The notification statement can be
• added to the top of a questionnaire or application form;
• explained orally to individuals;
• put in a publication (e.g. brochure) or other information about a program or service and provided to individuals;
• put in a poster on a physician’s office or pharmacy wall; or

• put in a pop-up screen as part of a computer program

An example of a health information notification statement is as follows:

“The health information that we are collecting is needed to determine your eligibility for the ______________ program, service or benefit (or to provide you with diagnostic, treatment and care services) (or for the training of students) (or for research or statistical purposes) (or for other authorized purpose(s) under section 27 of the Health Information Act). It is collected under the authority of the (Mental Health Act) (or Cancer Programs Act) (or Hospitals Act) (or Nursing Homes Act) (or Alberta Health Care Insurance Act) (and/or section 20(b) of the Health Information Act – directly related to and necessary to carry out an authorized purpose under section 27) (or other legal authority). The confidentiality of this health information and your privacy are protected by the provisions of the Health Information Act (and any other act that is appropriate to add).

If you have any questions about this collection and use of your health information, please talk to one of the staff (or contact) ____________ (position) at ___________ (business address) or phone ____________ (business phone).” 

Development Guidelines

1. Notifications must occur whenever health information is captured or recorded.  All data collected must be needed for each individual from whom it is collected.
2. Use of the collected health information can be used for the purpose described in the notification statement.   
3. Notifications may be printed on the collection form itself, on a separate or covering document that is a guide to the completion of the form, or may be given verbally.
4. Notifications should not be shaded and the type size should allow the notification to be clearly readable with average vision, preferably of the same type size as the rest of the body of the form.
5. Design of forms should place the notification either at the top of the form (before any health information is collected) or just above the signature line.
6. Oral notification is appropriate when information is recorded over the telephone, however if follow-up documentation is transmitted a HIA Notice providing the same information given over the telephone should be included.
7. Retention of personal information used to make a decision about an individual must be retained for a minimum of 1 year following the notification of the decision.
8. For further information or assistance contact the Information and Privacy Office at 492-9419.

HIA Guidelines and Practices Manual (page 192) and the HIA Guidelines and Practices Manual Appendix 1

January 2015