A duly appointed personal representative of a deceased adult or minor

Attorneys representing a duly appointed personal representative should provide the following when requesting a medical record:

1. A letter of request on your letterhead including the patient’s name, incident date, incident time and incident location
2. A copy of the document by which the person is the duly appointed personal representative
3. A copy of the Death Certificate
4. An authorization releasing the record that:
   • Is in writing, dated and signed by the personal representative
   • Identifies Singerly Fire Company as the health care provider
   • Identifies the patient
   • 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.