EMS Report Request

EMS Report Request

Requests are usually completed in 7 business days, but may take up to 30 days if the records must be retrieved from storage. The requester will be notified via phone or email when the report is ready to be picked up.

You must also complete a HIPAA Release of Information form for EMS report.

    Your Name*

    Your Address*

    Your Phone Number*

    Your Email*

    Date of Incident*

    Name of Patient*

    Relationship to Patient*

    Additional Comments

    * REQUIRED FIELDS.

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