Attorneys Representing a Patient
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. An authorization to release the record that:
- Is in writing, dated and signed by the patient
- 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
Note: Authorizations missing any of the required elements will not be accepted.
A Second Option
Submit a letter of request, along with a copy of the document by which the patient has appointed you to represent him or her. The letter of request must contain the patient's name, incident date, incident time and incident location.
Regardless of which option you choose, send all of the 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, Maryland 21286-5500
Revised May 12, 2016