Marshalls Creek Fire Company
Station 29 Marshalls Creek, Pa Fire/Rescue/EMS
EMS Records Request
Medical Records
Marshalls Creek Fire Company maintains medical patient data in a secure manner, allowing release only to recognized entities with legal right to view the contents.
After MCFC receives a completed authorization (and a request letter when needed), it will be completed in 10-14 business days to receive copy or notice of "NO RECORDS FOUND"
To comply with applicable laws, requests for medical records are unable to be processed over the phone. Patients may receive one copy of their medical records at no cost.
Completed requests for medical records will be mailed to the requesting party. Medical records are retained for a minimum of seven years.
If you are seeking records on behalf of a patient, please know that our staff is only allowed to discuss patient information with you upon receipt of any authorization from the patient. If you have a Power of Attorney for Healthcare Decisions or alternate legal document
If you are a parent of a child less than 18 years old, the parent must complete the authorization form. If the son or daughter is 18 years or older, they must complete the authorization form.
For deceased patients, the person listed at “Informant” or “Surviving Spouse” on the death certificate may receive a copy of the decedent’s PCR.
Required:
-
Legal photo ID
-
Completed Authorization for release of protected health (link).
-
If deceased, the death certificate is required.
Non-Patient Requestors
All non-patient medical record requests and accompanying signed authorization forms must be submitted via mail to the following address:
Marshalls Creek Fire Co
Attn: Medical Record Request
PO Box 1
Marshalls Creek PA, 18335
ATTENTION ATTORNEYS & THIRD PARTY REQUESTORS: To help us process your request and prevent any delay. Please provide a copy of the patient's government-issued ID so that we may validate the signature provided on the HIPAA authorization.
If you are seeking records on behalf of a patient, please know that our staff is only allowed to discuss patient information with you upon receipt of any authorization from the patient. If you have a Power of Attorney for Healthcare Decisions or alternate legal document
If you are a parent of a child less than 18 years old, the parent must complete the authorization form. If the son or daughter is 18 years or older, they must complete the authorization form.
For deceased patients, the person listed at “Informant” or “Surviving Spouse” on the death certificate may receive a copy of the decedent’s PCR.
Required:
-
Legal photo ID
-
Completed Authorization for release of protected health.
-
If deceased, the death certificate is required.
The following fees will apply to the records request, upon receipt of payment records will be released
Fee:
Search Fees
$27.14
Per Page Fees
1-20: $1.83 per page
21-60: $1.36 per page
61+: $0.47 per page
Patients
To request a copy of your medical records, you need to provide a written request. You can complete a request form we have provided by following one of the options below. If the patient is a minor, or unable to sign an authorization, the signature of an authorized legal guardian is required.
To mail your request:
Once you have filled out your request in its entirety, you may mail it directly to MCFC at:
Marshalls Creek Fire Co
Attn: Medical Record Request
PO Box 1
Marshalls Creek PA, 18335
Forms
Marshalls Creek Fire Company Medical Records Request (English)
Marshalls Creek Fire Company Medical Records Request (Spanish)
To mail your request:
Once you have filled out your request in its entirety, you may mail it directly to MCFC at:
Marshalls Creek Fire Co
Attn: Medical Record Request
PO Box 1
Marshalls Creek PA, 18335