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Attorney Representing a Court-Appointed Guardian or Custodian of a Minor Child

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 court order appointing the person as the guardian, custodian or representative of the minor.

3. A written authorization to release the record that:

  • Is signed and dated by the guardian, custodian, court appointed representative.
  • Identifies the health care provider.
  • 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.

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

A second option ...

Or, you may send a letter of request on your letterhead that includes the patient's name, incident date, incident time and incident location, along with a copy of the court order appointing the person as the guardian, custodian, or representative of the minor. You must also include a copy of the document by which the person has appointed you to represent him or her. 

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":

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

Revised May 16, 2013

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