Choose Report Type
Your Contact Information
(Example 999-999-9999)
Emergency Medical Services Report
(Example PF/PP 21092700000123)
Supportive Documents
You can add your digital letter of request here along with any supportive documentation. Supportive documentation can include:
  • A copy of your driver’s license if requesting your own documents.
  • Official letter of request from your office or law firm.
  • A signed HIPAA compliant release of records if requesting other parties’ records.
  • A power of attorney if the person is living but cannot request for themselves.
  • A Letter of administration or executor documentation if the party is deceased.