PharmaNet Patient Consent | Lakepoint Medical Clinic

PHARMANET

Patient Consent to Access PharmaNet
The Province of British Columbia has established the provincial computerized pharmacy network and database known as “PharmaNet" pursuant to section 13 of the Pharmacy Operations and Drugs Scheduling Act, S.B.C., 2003, c.77.

Only the patient or their legal representative may sign this form. It is not acceptable for a caregiver of the patient who is not the patient's legal representative to sign the form on behalf of the patient.
Patient name*
First Last
Date of Birth*
MM slash DD slash YYYY
I am signing on behalf of the patient
Legal representative or guardian*
First Last
Nature of legal relationship with the patient
- Dr. Peter Warren
- Dr. John McNern
I authorize the physicians listed above and persons directly supervised by him/her/them to access my personal health information contained within PharmaNet for the purpose of providing therapeutic treatment or care to me, or for the purpose of monitoring drug use by me. I understand that withdrawal of this consent must be in writing and delivered to the above-named physician(s).
Signed and delivered by*
Patient or representative (signature)

PHARMANET