CII Participation Forms – Specialist – Governance Structure

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The following steps outline the order in which forms should be completed for maximum efficiency. 

STEP 1: Review CII PIA Summary and Complete Endorsement

As you have indicated that there is a Primary Custodian at your clinic, have them sign the CII PIA Endorsement Letter, which acknowledges that your clinic has asked the EMR vendor to modify your system to share data with Alberta Netcare and Alberta Health. 

Note: If a custodian is signing on behalf of clinic or group of custodians, the letter should be copied to all who are involved.

Refer to the CII PIA Summary for an overview of the Alberta Health CII Privacy Impact Assessment.

STEP 2: Submission of Completed Forms

 Once the above letter is signed, fax them to:

            eHealth Support Services at 1-844-630-0877

 As well, mail the original copy of the PIA Endorsement Letter(s) to:

Ms. Jill Clayton

Information and Privacy Commissioner

Office of the Information and Privacy Commissioner

#410, 9925 – 109 Street Edmonton, AB  T5K 2J8

Related Pages

CII/CPAR Participation Forms - Family Practitioners

CII/CPAR Participation Forms - Specialist