Attorney Representing the Parent 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, And...
2. An authorization to release the record that:
- Is in writing, dated, and signed by the parent.
- Affirms the parent/child relationship.
- Affirms that the parent's authority to consent to health care for the minor has not been specifically limited by a court order or a valid separation agreement entered into by the parents.
- Identifies the Baltimore County Fire Department as 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:
You also may provide a letter of request on your letterhead that includes the patient's name, incident date, incident time and incident location, and that affirms the parent/child relationship and that the parent's authority to consent to health care for the minor has not been specifically limited by a court order or a valid separation agreement entered into by the parents. You must also provide a copy of the document by which the parent 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":
Records Department
Baltimore County Fire Department
700 East Joppa Road
Towson, MD 21286-5500
Revised April 13, 2010
