A court-appointed guardian, custodian, or representative of a minor child

Attorneys representing a court appointed guardian or custodian of a minor child should provide the following when requesting a medical record:

1. A letter of request on your letterhead that includes the patient’s name, incident date, incident time and incident location
2. A copy of the court order appointing the person as the guardian, custodian or representative of the minor.
3. A written authorization to release the record that:
   • Is signed and dated by the guardian, custodian, court appointed representative.
   • Identifies Singerly Fire Company as the health care provider
   • Identifies to whom the record is to be provided.
   • States the time period for which the authorization will be valid, which may not exceed one year.

Note: Authorizations missing any of the required elements will not be accepted.

Send all of the required documentation with a check or money order to “Singerly Fire Company” to:

Singerly Fire Company
Attention: Assistant Chief for EMS
PO Box 444
Elkton, MD  21922-0444

Walk-in requests are not accepted.