Brevard County Fire Rescue Medical Records Request Information

In order to request an EMS Patient Care Report from Brevard County Fire Rescue, the individual must provide the information indicated under the type of request:

Patient / Personal Representative

• Request in written form, preferably notarized
• Legible copy of requestor's drivers license or state photo ID, this includes picture being legible
• Personal Representative must provide legal documentation such as Power of Attorney, Birth Certificate (for minors), death certificate, etc.
• All requestors must sign a copy of the BCFR Authorization for Release of Medical Information Form

Attorney Offices

Please include a properly executed subpoena, or HIPAA release of information form signed by the patient or patient’s legal medical representative with appropriate witness signature.

Law Enforcement for Active Investigations

Please include a written request on official department letterhead for a specific incident or patient that is currently under an active investigation.

DCF

Please include a written request on official letterhead for a specific incident or patient that is currently under investigation.

Medical Examiner

Request must include a written request on official letterhead for a specific incident or patient.

RTI (Tissue Donation)

Request must include a written request on official letterhead for a specific patient and release documentation from the patient or personal representative.

Hospital

Request must be in written form on either official letterhead or via email for a specific patient from a recognized health care professional.