San Marcos, CA · San Diego County
Health Information Release Authorization
Patients or authorized representatives use this form to request access to health information maintained by the San Marcos Fire Department.
What this form is
This form requests access to health information held by the San Marcos Fire Department, including medical care reports, ambulance bills, or incident reports. It asks for the requestor’s and patient’s information, their relationship, the requested records, and a signature and date. Include the patient’s signed government-issued identification, any required representative documentation, and a completed San Marcos Fire Department Incident Report request.
Who needs it
A patient or the patient’s legal or authorized representative seeking access to health information maintained by the San Marcos Fire Department needs this form.
How to submit it
Email the form to [email protected], submit it online at sanmarcosca.justfoia.com/publicportal, or mail it to the San Marcos City Clerk, 1 Civic Center Drive, San Marcos, California 92069-2918.
About notarization
This document is signed without a notary; the signer signs and dates the form, and the listed supporting documents are not described as notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Health Information Release Authorization form.
- 2
Complete The Request
Provide the requestor and patient information, relationship, requested information, and request date; then sign and date the form.
- 3
Gather Supporting Documents
Include the patient’s signed government-issued identification, any required representative documentation, and a completed San Marcos Fire Department Incident Report request.
- 4
Submit To The City
Email, submit online through the listed portal, or mail the form and supporting documents to the San Marcos City Clerk.
Frequently asked questions
- Do I need a notary for the Health Information Release Authorization?
- No. The form is signed and dated without a notary; the listed supporting documents are not described as notarized or sworn.
- How do I submit the Health Information Release Authorization?
- Email it to [email protected], submit it through the listed online portal, or mail it to the San Marcos City Clerk at the address on the form.
- What supporting documents must I include?
- Include a copy of the patient’s valid government-issued identification with their signature. If you are not the patient, also include documentation of legal representation or authorized representative status, and a completed Fire Department Incident Report request.
- What health information can I request?
- The form lets you request health information maintained by the San Marcos Fire Department, with options including a medical care report, ambulance bill, or incident report.
Need something notarized?
This Health Information Release Authorization doesn’t need a notary — but if you have another San Marcos form that does, a commissioned online notary can help.