Emergency Medical Services (EMS) and Fire Report Request

EMS reports are considered confidential medical records, and are protected by privacy laws,
including the Health Insurance Portability and Accountability Act (HIPPA) and other applicable
medical confidentiality considerations. Please use the attached Authorization for Release Of
Protected Health Information form to request the record. A clear legible copy of photo
identification (driver’s license) must accompany and be attached to the request prior to
release of the report.

Third party requests generally require either an authorization signed by the patient
or a court order specifically compelling the Cumberland Fire Department (“Department”) to
disclose the specific information sought.

The Department may give a report for a deceased individual to the personal representative
of the estate with completed Authorization for Release of Protected Health Information, a
copy of the death certificate and letters of authority from the Probate Court showing the
appointment of the said personal representative.

A report may be released to the person’s power of attorney, guardian (with proof of legal
guardianship), a healthcare decision maker (or an individual who is authorized to make
health care treatment decisions for the patient including the parent of a minor or an agent
pursuant to a healthcare power of attorney) with completed Authorization for Release of
Protected Health Information and a copy of the healthcare power of attorney if applicable.

If you are requesting EMS records:

Complete and submit the Request Form for Fire/EMS Incident Report and Authorization
for Release of Protected Health Information Form by email drand@cumberlandmaine.com or
mail to:

Cumberland Fire Department
Attn: Fire/EMS Reports
36 Tuttle Road
Cumberland, ME 04021