Request for Patient Records
Patient Medical Records (Individual Requests)
For patients treated and/or transported via ambulance by the BHFD, correlating patient medical records can be requested by the patient or his/her authorized representatives. Medical records are highly confidential under Federal and State law and thus, the BHFD must follow strict guidelines when releasing them. Said guidelines ensure that your medical records and protected health information (PHI) remain confidential.
A patient or authorized representative may request copies of medical records at no cost by following the instructions below:
-Complete both sides of the BHFD Authorization for Use & Disclosure of PCR. If a patient is incapacitated or otherwise unable to sign the form and an authorized representative is acting on their behalf, the representative's relationship must be identified in section C. Official documentation proving the representative's legal authority to act and sign on the patient's behalf must be provided, such as a birth certificate (of minor patient), death certificate, or power of attorney.
-Include a photocopy of the signatory's valid and unexpired government-issued photo ID. In lieu of a government-issued photo ID, a signature can be notarized.
-Submit the BHFD Authorization for Use & Disclosure of Patient Care Record (PCR) form and supporting documents to:
Patient Medical Records (Law Offices)
Law offices requesting patient medical records on behalf of their clients must also complete and sign the BHFD Authorization for Use & Disclosure of PCR. There is no cost to request records. For information on requesting patient billing records, please visit the Ambulance Billing page.
Subpoenas for records can be served Monday-Friday from 8:00AM-5:00PM at BHFD Headquarters, 445 N. Rexford Drive, Beverly Hills, CA 90210. Please visit the cashier at Beverly Hills City Hall at 455 N. Rexford Drive to pay the $15 subpoena fee before serving the subpoena at the Fire Department.
City Attorney, District Attorney, and Law Enforcement
Federal regulations, 45 CFR 164.512(f)(1)(ii) state that a release from the patient is not needed but a court order, warrant, subpoena, summons, administrative subpoena, or authorized investigative demand must be provided.
For Beverly Hills Police Department personnel requesting patient medical records, please complete the Request for Intradepartment PHI.
For assistance with medical records requests, please contact the Fire Administration office at (310)281-2700.