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 $10, payable to "Baltimore County Office of Finance" :
Records Department
Baltimore County Fire Department
700 East Joppa Road
Towson, MD 21286-5500
Revised April 13, 2010
