Records Request Instructions

STEP # 1 – Fill out the Records Request Form and sign it:

 Download and fill in all applicable sections in Albuquerque Fire Rescue’s Record Request Form

https://www.cabq.gov/fire/documents/abq-fire-record-request-form.pdf/view

STEP # 2 – Attach Applicable Documents (For Medical Records Only):

A medical record is any record (i.e. fire report, medical report or 9-1-1 tape/CD) that is not redacted and contains protected health information about a patient.

For more information about Albuquerque Fire Rescue’s policy regarding patient privacy rights, go to: Notice of Privacy Practices.

Patient Request:

If you are a patient in need of a medical record, be prepared to provide identification (government issued photo I.D.) when submitting the Record Request Form.

Third Party Request:

If you are requesting a medical record and you are not the patient, you must attach one of the following to the Record Request Form:

• A notarized HIPAA-compliant release (see 45 C.F.R.164.508 for required contents of release) signed by the patient
• A court order signed by a judge authorizing the release (45 C.F.R. 164.512).

*A subpoena alone, without either a HIPAA-compliant release or court order attached, is not sufficient to authorize release of a patient’s medical record.

Deceased:

If you are requesting a medical record for a deceased patient a death certificate and proof of executor of the estate are required.

Child:

If you are requesting a medical record for your child a birth certificate (of the child) and picture I.D. (of the parent) are required.

Fire Report with a Casualty:

In order to obtain a fire report with casualty information included, the above mentioned documents are required for the medical record.

STEP # 3 – Send the Signed Records Request Form and applicable documents to Albuquerque Fire Rescue's Records Management Services.

Send the form and applicable documents by mail or in person to:

Records Management Division
Albuquerque Fire Rescue
7520 Corona Ave NE, Albuquerque, NM 87113

Phone: 505-764-6333
email: [email protected]