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 844-371-0634.
• Email the completed form to emsmedicalrecords@charlescountymd.gov

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.