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Kootenai County EMS System

Record Request Policy and Forms

Medical Records Request (Requested by Patient)

Medical Record Request Form

This form is used to request medical patient care records only. This can only be requested by the patient, patient guardian, or person assigned as patients Medical Power of Attorney.

Instructions: Please print the form and fill out completely including signature at the bottom of the form by the patient, patient guardian, or medical Power of Attorney. Fax or mail the completed form (along with proof of guardianship or POA if patient is not signing) to Kootenai County EMS.

FAX: (208) 930-4259
MAIL: KCEMSS, 4381 W. Seltice Way, Coeur d'Alene, ID 83814

Email is not advised - email is not secure and the security of your personal information is important to us.

Medical Records Request (Third Party Professional)

Request records through ChartRequest

Use the link above to be directed to ChartRequest to securely request records on behalf of your client.

KCEMSS Certification for Release of Protected Health Information

Use the link above to download the release of PHI form.

Public Record Request Form (General Non-Patient Request)

Public Record Request Form

This form should be used for all record requests EXCEPT FOR requests for patient information or medical records. Patient information is protected by HIPAA and is exempt from public record requests.

Public Record Request Policy

Public Record Request Policy

Please read the Kootenai County EMS record request policy above, as some requests may be subject to fees, depending on the time it will take to complete the request.

Instructions: Print the Public Record Request Form and fill out the top section completely with detailed information on what you are specifically requesting. Please send completed request to KCEMSS by either fax or email for the quickest response.

FAX: (208) 930-4259
Email: info@kcemss.org