Medical records are protected by HIPAA rules and regulations. These reports will only be released to and/or with:
- Patients
- Attorneys with a Medical Authorization Release form
- Power of Attorney documents
- Parents of minors: must have a copy of birth/death certificate as well as a notarized signature
- Spouses or next of kin without power of attorney: must have a copy of death certificate as well as a notarized signature
- Police agencies
- Subpoenas
In the event of a death: The next of kin may obtain medical records with a copy of either the death certificate or power of attorney documents, along with a letter of request.
Attorney requests: A request on letterhead indicating the patient's name, date, time and location of incident along with a Medical Authorization Release Form signed by the patient/power of attorney and a self-addressed stamped envelope.
Incident Report Request Form(PDF, 337KB)
Directions for Submissions
- Complete, sign, and notarize the Incident Report Request form
- Mail completed form, necessary supporting documentation, and a self-addressed, stamped envelope to:
Mesa Fire Records/Technical Services
P.O. Box 1466, MS6060
Mesa, AZ 85211-1466
Notice of Privacy Practices
The Notice of Privacy Practices is relevant to patients treated or transported by Mesa Fire and Medical Department. The Notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Notice of Privacy Practices(PDF, 154KB)