Medical Records Request

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Please be advised: Fees may apply when requesting records. For more information on the fees charged by the District, please review the fee schedule below.

Fee Schedule

Current Person Requesting Records
Patient Information
Authorization
Preview
Complete

Date of Request

Incident Date

Incident Location

Full Name

Organization

Phone

Address

Address 2

City/Town

ZIP/Postal Code

Reason for Request

Administration Building

Elizabeth Fire Station 271

Hours

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