EMS Patient Care Report Request

All requests for Patient Healthcare Information (PHI) shall be immediately provided to the Privacy Officer to respond. Requests for PHI that are authorized under HIPAA shall include the following: 

  • A properly signed and executed Liberty Township Fire Department Request to Access Own PHI or other appropriate release. 

  • The appropriate fee, in accordance with the current fee schedule, and/or postage (if the requested records are to be mailed) for obtaining copies of the requested records. Only cash or check are accepted. Checks shall be made payable to “The Liberty Township Fire Department.” 

  • Requests over the phone for PHI cannot be honored under law. 

  • The requestor must be present and have valid identification. 

  • If the patient is a minor, a parent or legal guardian may obtain a copy of his or her medical record. 

For additional information, contact Liberty Township Fire Station 321, 740-938-2021. Ask for the officer in charge or, contact Battalion Chief Brian Niemet for further information on requesting an EMS report.