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 $15, payable to "Baltimore County Maryland":
Baltimore County Fire Department
700 East Joppa Road
Towson, MD 21286-5500
No walk-in requests will be accepted.
Revised February 23, 2015
Revised April 6, 2016