This form cannot be used to request medical records as they are not public record.
To request your own medical record for an ambulance transport, you need to schedule an in-person appointment and present your photo ID.
If you are an attorney seeking a record for a client you will need to present an authorization to disclose protected health information signed by the patient.
When Albany Fire Department staff receives the request, they will determine if a report is available, calculate the cost of providing a copy of the report, and contact you with instructions for submitting payment.
The cost varies depending on the size of the report ($7 - $25 average). The fees are allowed under ORS 192.440(3).
For more information on obtaining medical records, call 541-917-7710. For more information on other requests, call 541-917-7700.