Spouses or next of kin without power of attorney copy of death certificate as well as a notarized signatureĪttorney Request: A request on letterhead indicating the patient's name, date, time and location of incident along with a Medical Authorization Release Form signed by the patient/power of attorney and a self-addressed stamped envelope. Parents of minors: must have a copy of birth/death certificate as well as a notarized signature.Attorneys with a Medical Authorization Release form.Reports will only be released to and/or with: Medical information is protected by HIPAA rules and regulations. Please bring a self-addressed, stamped business-size envelope with you in order to. In the event of a death, the next of kin may obtain these records if they can produce a copy of either the death certificate or power of attorney documents, along with a letter of request and self-addressed stamped envelope. The District 87 Student Teacher packet is sent electronically to. Medical Report Release: These records are confidential and require a notarized signature of the patient. Mail your request and a self addressed stamped envelope to: Procedure for Requesting Records:įull Incident Record Request (Use this form for patient records, fire investigation reports, fire investigation photos or 911 recordings) They also communicate with the general public, other City employees, and representatives of public, city, state, county, and federal agencies in providing information, answering inquiries, and responding to sensitive requests. A self-addressed stamped envelope (SASE), stamped self-addressed envelope (SSAE), or stamped addressed envelope (SAE) is an envelope with the senders name and address on it, plus affixed paid postage, that is mailed to a company or private individual. The Records Division develops, plans, organizes and coordinates the computerized records management system, retention, retrieval, storage, and disposition functions for the Fire Department. Please include a self-addressed, stamped envelope if you want your materials.
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