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Requesting a Client's Records

If your client has been treated by the San Francisco Fire Department and you require a copy of your client's medical and/or billing records for legal purposes, you may do so by providing a legal subpoena or authorization using the SFFD Patient Authorization Form (pdf).  Requests may be for either medical record, billing record, or both.  ALL REQUESTS MUST INCLUDE APPLICABLE FEES AND PROPER DOCUMENTATION AT THE TIME OF SUBMITTAL, unless a fee is prohibited by law.  INCOMPLETE REQUESTS WILL BE SUBJECT TO DENIAL.  Please refer to the instructions below as it applies to your request.
 

SUBPOENAS:

All subpoenas must include patient name, injury date and case number. All civil subpoenas must additionally include clear documentation of Proof-of-Service that opposing parties have been served. Subpoenas MUST be hand-delivered with fee payment to:

SFFD - EMS Division
Medical Records Unit
1415 Evans Avenue
San Francisco, CA 94124

 

Please review your subpoena for thorough documentation prior to delivery and call the Custodian of Medical Records to arrange drop-off and pick-up times to ensure service efficiency. For payment, please refer to the Fee Schedule below. Subpoenas received incomplete shall be subject to denial.
 

PATIENT AUTHORIZATIONS:

Requests submitted must include a cover letter on your company's letterhead describing the records being requested, an authorization using the SFFD Patient Authorization Form (pdf), and fee payment. The required authorization form must be completed properly, including patient name and injury date, and must be SIGNED BY THE PATIENT. Please mail your request along with fee payment to:

SFFD - EMS Division
Medical Records Unit
1415 Evans Avenue
San Francisco, CA 94124

 

Please review your request for thorough documentation prior to delivery. For payment, please refer to the Fee Schedule below. Requests received incomplete shall be subject to denial.  Please do not send via Registered Mail.

SFFD Patient Authorization Form (pdf)
 

FEE SCHEDULE:

Please include payment at the time of request and make checks payable to " SFFD-EMS".
 

Record Fee
 Medical Record $18.00
 Ambulance Bill $18.00
 Medical Record AND Ambulance Bill (for same incident) $24.00
 Retrieval-from-Storage Fee * $27.00


 

 

 
 

 

 

* Requests for Medical Records regarding incidents which occurred on or before 12/31/2007 MAY be subject to the $27.00 Retrieval-from-Storage Fee in addition to the regular processing fee.  If you have any questions, please contact the Custodian of Medical Records.
 

WITNESS INTERVIEW OR DEPOSITION: 

To request an interview with Fire Department personnel regarding your case (e.g., ambulance or engine crew members), please review the link below:
 

Subpoena Fire Department Members for Deposition or Court Appearance

 

 

 

 

 

Last updated: 8/1/2011 12:35:58 PM