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
700 East Joppa Road
Towson, MD 21286-5500
Revised May 16, 2013