Emergency Medical Services (EMS) Report Release Information
Emergency Medical Service (EMS) Reports
EMS reports are considered confidential medical records, and are protected by privacy laws, including the Health Insurance Portability and Accountability Act (HIPPA) and other applicable medical confidentiality considerations. Please use the attached “Authorization For Release Of Protected Health Information Form” to request the record. A clear legible copy of photo identification (driver’s license) must accompany and be attached to the request prior to release of the report.
Third party requests generally require either an authorization signed by the patient or a court order specifically compelling the Palmer Fire Department ("Department") to disclose the specific information sought.
The Department may give a report for a deceased individual to the personal representative of the estate with completed “Authorization For Release of Protected Health Information Form”, a copy of the death certificate and letters of authority from the Probate Court showing the appointment of the said personal representative.
A report may be released to the person's guardian (with proof of legal guardianship), a healthcare decision maker (or an individual who is authorized to make health care treatment decisions for the patient including the parent of a minor or an agent pursuant to a healthcare power of attorney) with completed “Authorization For Release of Protected Health Information Form” and a copy of the healthcare power of attorney if applicable.
If you are requesting EMS records: Complete and return the following two forms to the Palmer Fire Department
- Incident Report / Records Request Form for Fire/EMS
- Authorization for Release of Protected Health Information
- A copy of your state or federal issued ID (Drivers License, Passport, State ID card)
Completed forms should be returned in person or mailed to;
Palmer Fire Department
Attn: Deputy Chief John Fitzgerald
12 Walnut Street Palmer, MA 01069