The Ravena Rescue Squad - Request for information Forms
All correspondence will be performed by mail after proper identification of the patient have been made to ensure that the person requesting the information is in fact entitled to that information. Your personal health information security is important to us and we will do everything possible to ensure it is secure and does not fall into the wrong hands.
Important Notes
- Patients will have the option to obtain their medical records in 2 way.
- By Mail with the Patient Info Request By Mail Paperwork. **** This form will need to be notarized. ****
- In Person with the Patient Info Request In Person Paperwork. **** The Person dropping off this form will need a Photo ID. ****
- By Mail with the Patient Info Request By Mail Paperwork. **** This form will need to be notarized. ****
- When Requesting information for a Juvinal Patient as a Parent a Copy of a Birth Certificate or Custody Paperwork will need to be provided.
- Legal Requests - Law Enforcement and Law Offices will need to submit a OCA Official Form No 960 signed by the patient.
- For Legal and Power of Attorney Requests all appropriate legal documents not limited to: Subpoena, Power of Attorney, Attorney Medical Information Release. ect.
- In the event additional information is required please ensure that contact information for the person requesting the information is included.