Attorneys Representing a Patient

Please 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:

A.)  Is in writing, dated, and signed by the patient.

B.)  Identifies the Baltimore County Fire Department as the health care provider.

C.)  Identifies to whom the record is to be provided.

D.)  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.

Or...

3. A letter of request from you will be sufficient, if you also provide 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. 

Send all  of  the 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