Web Mailing Address Fax Call Centre
SAFE BC www.WorkSafeBC.com ——_ PQ Box 4700 Stn Terminal 604 233-9777 604 231-8888
Vancouver BC V6B 1J1 1 888 922-8807 1 888 967-5377

WORKING TO MAKE A DIFFERENCE

February 20, 2026

Royal Columbian Hospital
ATTN: Health Records

Fax: 604-520-4724

To the Health Care Provider:

REGARDING: MARK HOLAND

DATE OF INJURY: January 12, 2026

PERSONAL HEALTH CARE NUMBER: 9128549738
DATE OF BIRTH: September 04, 1978
WORKSAFEBC CLAIM NUMBER 42647461

Please provide copies of any and all MEDICAL RECORDS (including all chart notes,
diagnostic imaging, testing and consultation reports) relating to this worker's EARS
(BOTH SIDES), and/or MIGRAINES dated on or about JANUARY 1, 2021 to
PRESENT.

It is important that only medical information relevant to the compensable injury is
provided, as the entire claim file will be disclosed to the worker, the employer and
their authorized representatives in the event of an appeal.

Under both the Workers Compensation Act and the Freedom of Information and
Protection of Privacy Act, WorkSafeBC is given authority to receive all medical
information pertaining to this worker’s injury, as it is considered necessary for the
adjudication of the claim, and to return or destroy any irrelevant information.

A copy of the claimant’s authorization for the release of this medical information is
attached.

Enclosed is the Request for Hospital Records form. Use the attached request form as
your cover sheet. This will ensure a timely submission to the worker's claim file. Include
the worker’s name and claim number on all information submitted.

Please fax the requested information to 604 233-9777 or toll free at 1 888 922-8807, or
the information may be mailed to:

WorkSafeBC
PO Box 4700 Stn Terminal
Vancouver BC V6B 1J1

PLEASE INCLUDE CLAIM OR ACCOUNT NUMBER IN ALL CORRESPONDENCE

Workers’ Compensation Board of British Columbia
D0277 NOV 2010 -MD -M