A parent of a minor child

Attorneys representing the parent 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. An authorization to release the record that:
   • Is in writing, dated, and signed by the parent
   • Affirms the parent-child relationship
   • Affirms that the parent’s authority to consent to health care for the minor has not been specifically limited by a court order or a valid separation agreement entered into by the parents
   • Identifies the 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.