|
The
Fire Incident Report Request Form (PDF)
The
Fire Incident Report Request Form
(TXT)
The Fire Incident Request Form is required in
order to obtain copies of an incident report.
Record requests will be ready within five (5) working
days of receipt of your request. Reports are
provided free of charge to any individual
involved in the incident. Others must purchase a
copy of the report.
You may fill out the report on-line then print
and mail to:
Peoria Fire Department
Attn: Records Management - Fire
8401 W Monroe
Peoria, AZ 85345
Indicate on the form by checking the appropriate
box whether you want the records mailed or
whether you will pick them up at our office. If
you wish them mailed, enclose a stamped,
self-addressed envelope. Records will be ready
within 5 working days of receipt of the request
Enclose a check payable to the "City of Peoria"
for the amount required per report, as noted
below.
$10 if the request is within 30 days of the
incident.
$20 if the request is more than 30 days after
the incident date.
You may also make the records request in person
at the Fire Department Administration Offices
at:
8351 W Cinnabar
Peoria, AZ 85345
EMS Incident Report
(PDF)
EMS Incident Report (TXT)
The EMS Incident Report Request Form is required
in order to obtain copies of an EMS incident
report. The EMS Report request form must be
submitted in person at the Fire Department
administrative offices, 8351 W Cinnabar Peoria,
AZ. The only exception to presenting in person,
is if the request form is accompanied by a court
order mandating release of the record.
Medical records will only be released to the
patient involved, unless:
* A court ordered subpoena is presented.
* A signed HIPPA Release Form and Power of
Attorney is presented.
* The patient is a minor child, in which case
the parent or guardian must present picture ID
when the request is made.
* The patient is deceased, in which case the
family member requesting the record must present
a copy of the death certificate.
There will be no exceptions to these
requirements.
If you are submitting the request by mail,
please send to:
Peoria Fire Department
Attn: Records Management - EMS
8401 W Monroe
Peoria, AZ 85345
Indicate on the form by checking the appropriate
box whether you want the records mailed or
whether you will pick them up at our office. If
you wish them mailed, enclose a stamped,
self-addressed envelope.
Reports are provided free of charge to the
patient. Others must purchase a copy of the
report. Fees are as follows:
$10 if the request is within 30 days of the
incident.
$20 if the request is more than 30 days after
the incident date.
Enclose a check payable to the "City of Peoria"
for the amount required per report. Records will
be ready within five (5) working days of receipt of the
request.
|
