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Attorney Representing a Person Authorized to Consent to Health Care

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 authorized to consent to health care

3. An authorization to release the record that:

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

    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, the reason the record is being requested, along with

  • A copy of the document by which the person authorized to consent to health care has appointed you to represent him or her
  • A copy of the document by which the person is authorized to consent to health care

Note:  A "Reason for the Request" is required in accordance with Maryland Public General code; Health-General, TITLE 4, Statistics and Records, SUBTITLE 3, Confidentiality of Medical Records: 4-301 (k) (2) states that a person authorized to consent to health care for an adult who requests a copy of a medical record is a person in interest when  "consistent with the authority granted."

Regardless of the 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

No walk-in requests will be accepted.

Revised May 16, 2013

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