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Appointed Personal Representative of a Deceased Patient

If you are the personal representative of a deceased patient, print this Patient Care Report Request form (PDF) and carefully follow the instructions on the form, including the instructions for returning it by mail. 

The Fire Department will make every effort to respond to your request as quickly as possible. In most cases, you will receive a response within 10 working days.

If you are not a personal representative of a deceased patient, please choose the description that applies to you.

Revised May 17, 2013

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