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Attorney Representing a Duly Appointed Personal Representative

Provide the following:

1. A letter of request on your letterhead that includes the patient's name, incident date, incident time and incident location

2. A copy of the document by which the person is the duly appointed personal representative

3. A copy of the Death Certificate

4. An authorization to release the record that:

  • Is in writing, dated, and signed by the personal representative
  • Identifies the Baltimore County Fire Department as the health care provider
  • Identifies the patient
  • Identifies to whom the record is to be provided
  • States the time period for which the authorization will be valid, which may not exceed one year

    Note: Authorizations missing any of the required elements will not be accepted.

A Second Option

You also may send a letter of request that includes the patient's name, incident date, incident time and incident location, along with:

  • A copy of the document by which the duly appointed personal representative has appointed you to represent him or her
  • A copy of the document by which the person is the duly appointed personal representative
  • A copy of the Death Certificate

Regardless of which option you choose, send all required documentation with a check or money order in the amount of $15, payable to "Baltimore County Maryland" :

Baltimore County Fire Department
Records Office
700 East Joppa Road
Towson, Maryland 21286-5500

Revised May 27, 2015

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