To obtain a copy of your EMS report, please complete the Authorization For Release of Medical Information form. Once you have completed and submitted the Authorization For Release of Medical Information form, our medical/legal custodian of records will contact you to confirm your identity and retrieve any additional supporting documents needed to process the request. Please note reports may be delayed if they are awaiting completion or missing information.
Required fields are marked with an asterisk (*).
Patient Care / Incident Report Information
All incident report requests are processed within 7 business days upon receipt. It is our policy to fulfill record requests within 10 business days of the incident date. The department may require additional time to process more difficult requests and if so, an estimated time frame will be provided to the requestor.
Requests for an amendment to your record and requests for restrictions of the use and disclosure of your information should be made by completing a separate form.
Patient Authorization Disclosure
The CAPTCHA is case sensitive.