Attorney's Request for Medical RecordsTo request a copy of medical records please submit the following items:1. The Patient Authorization Form - this must be signed and notarized. 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 645 St. Catherine Florissant, MO 63031 For the necessary forms, click on the following links: Patient Authorization Form Acknowledgement of Receipt of Notice of Privacy Billing information may be obtained from our billing agency, Mediclaims, Inc. at (800) 538-8278. If you are requesting a certified copy, you will need to provide an affidavit. |