What a Mental Health Act representative consent statement asks for — and how to autofill 014-1471-41 with my-id.ca
Authorize or refuse clinical record access as a patient's representative without retyping party details
Representatives appointed under the Mental Health Act repeat the patient's name, the representative's contact information, and psychiatric facility identifiers when giving or refusing consent to access or disclose a clinical record. This guide is an example of storing them once in my-id.ca.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Mental health services — ontario.ca
- Form (Central Forms Repository): Statement of Representative Appointed Under the Mental Health Act to Give or Refuse Consent on Patient's behalf to Access or Disclose Clinical Record — 014-1471-41
What this form is about
Form 014-1471-41 is the Statement of Representative Appointed Under the Mental Health Act to Give or Refuse Consent on the Patient's Behalf to Access or Disclose a Clinical Record, used when a lawful representative exercises record access rights for an involuntary or other patient under the Act — confirm authority on ontario.ca.
Before you start: what to gather
- Patient full legal name and psychiatric facility name and address.
- Representative full legal name, address, and contact.
- Appointment documentation (court order, board order, or substitute decision-maker status).
- Consent decision (grant or refuse access) and scope of disclosure.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your patient and representative names, addresses, and facility contact in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- Who may complete this statement?
- A representative with lawful authority under the Mental Health Act — confirm roles on ontario.ca.
- How does my-id.ca help?
- It autofills patient, representative, and facility addresses across Mental Health Act forms.
- Is this a PHIPA correction request?
- No — this form is specific to Mental Health Act representative record consent, not general PHIPA correction.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.