FEEDBACK

Patient Enquiry Form

Please use this form to send us an enquiry about a patient who is within one of our hospitals.

Please note: In some circumstances we may not be able to respond positively to your patient enquiry. The Canterbury District Health Board maintains a record of patient illness(es) and treatments and is required to keep this information confidential. There are clearly stated rules for the release of any information under the Health Information Privacy Code 1994 (HIPC) and other legislation. The HIPC allows general comment on a patient's condition through the patient enquiries service unless the patient states otherwise.

Enquiry Details (fields marked with * are required)
Your Full Name: *
Your Address:
Your Phone No:  (incl. country code)
Your Fax No:  (incl. country code)
Your Email Address: *
Patient Name: *
Patient Address:
Patient DOB:
At which facility is patient located ?: *	--PLEASE SELECT FACILITY-- Akaroa Hospital Ashburton Hospital Burwood Hospital Christchurch Hospital Christchurch Womens Hospital Darfield Hospital Ellesmere Hospital Hillmorton Hospital Kaikoura Hospital Laboratory Services Mental Health Services Older Persons Health Services Oxford Hospital The Princess Margaret Hospital Tuarangi Home Waikari Hospital UNKNOWN/OTHER
Patient location within facility:
Comments/Enquiry: *

CDHB Feedback

---

 © Canterbury District Health Board 2003 | Legal Notice