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 it to:
  • Charles County Emergency Medical Services, 200 Baltimore St., La Plata, MD 20646

• Drop off / pick up location
  • Charles County Emergency Services 10665 Stanhaven Pl., Suite 208 White Plains, Maryland 20695

• 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.

Yes. There is a $20 fee to obtain an electronic copy and $22 for mailed copies of medical records

We can mail the copy of the requested records to the address listed on the authorization form, or you may pick them up during our office hours using a valid ID. Our office hours are Monday through Friday, 8:30 a.m. to 4:00 p.m. Please note that there is a paper copy fee of $22.