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Home > Divisions > Ambulance Services > Request Medical Records

To request a copy of medical records please submit the following items:

1. The Patient Authorization Form - this must be signed.
2. The Acknowledgement of Receipt of Notice of Privacy Practices Form.
3. A check or money order in the amount of $15.00.
Send your request with the appropriate forms and a check or money order made payable to:

Florissant Valley Fire Protection District
661 St. Ferdinand
Florissant, MO 63031

For the necessary forms, click on the following links:

Patient_Authorization_Form.pdf

Acknowledgement_Receipt_Notice_of_Privacy.pdf

If you need more information, you may email Diane at dkaatman@fvfpd.com

Billing information may be obtained from our billing agency, Mediclaims, Inc. at (800) 538-8278.