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Medical Records Request

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How do I obtain my Medical Records?

Patient Request

To request your medical records, complete the Release of Protected Health Information form (this form is only to be filled out if you’re the patient). Once you completed the form, you can send it to us by the following methods:

  • Mail or Drop it off to (Monday through Friday 8:00 a.m. - 4:00 p.m.):
    • Charles County Emergency Medical Services
      10425 Audie Lane
      La Plata, Maryland 20646
  • Fax the completed form to 301-392-3796.
  • Email the completed form to
Lawyer Request
To request medical records, we would need a cover letter indicating patient name, date of incident and date of birth along with a medical release authorization form completed by the patient or a Subpoena.
Third Party Request

This is for all request that meets one of the following criteria:

  • A parent if the patient is under 18 years of age
  • Legal Guardian (must provide proof of guardianship)
  • Power of Attorney (the power of attorney documentation must be attached)
  • Representative of an estate of deceased patient. (must provide proof of representation and death certificate)

Complete the HIPAA Authorization for the Release of Patient Information form and submit the completed form via one of the above methods.


Is there any fee for requesting medical records?
How long does it take to receive the records?
Typically our time frame is two weeks. However, by law, we have up to thirty days to complete the request.
Will you mail the copies or will i have to pick them up?
We can mail the copies to the address listed on the authorization form, or you may pick them up during our office hours using a valid ID. Our office hours are Monday through Friday, 8:00 a.m. to 4:00 p.m.
Who should I talk to about additional medical records questions/information?
You may contact Brandi Willey-Stewart at 301-609-3417 for any additional questions regarding medical records.
Who do I talk to in reference about the bill I received?
You may contact Sherry Herd at 301-609-3403 or for any questions regarding EMS billing.

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