Alden, NY · Erie County
Application to Inspect Medical Information
This form lets patients or authorized representatives request to inspect, receive a copy of, or obtain an electronic copy of Erie County medical and billing records.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Use this application to identify the patient, the county department and records involved, and the preferred way to access the information. Erie County directs applicants to return the completed form to its Chief Privacy Officer. Requests submitted by mail require notarization; in-person requests have the verification options described on the form. Authorized representatives must also provide documentation of their authority.
Who needs it
Patients seeking access to Erie County medical or billing information, and representatives requesting records on a patient's behalf, can use this application.
Why it needs a notary
The form has an acknowledgment block, not a jurat; the individual named in the application must personally appear before the notary and acknowledge signing it.
How to get this notarized
- 1
Download the Application
Get the Application to Inspect Medical Information from Erie County.
- 2
Complete the Form
Enter patient and request details, choose an inspection or copy option, and include representative information and supporting authority documents if applicable.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary for the acknowledgment required for mailed requests.
- 4
Sign on Video
Personally appear by video and acknowledge signing the application before the notary.
- 5
Submit to Erie County
Return the completed application to the Chief Privacy Officer using the address or email printed on the form.
Preview the form
The blank PDF straight from Alden. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I submit this medical information application?
- Complete the form and return it to the Erie County Chief Privacy Officer at the address or email listed on the application. The form states that mailed requests require notarization.
- Do I need to notarize this form?
- Notarization is required for requests submitted to Erie County by mail. The form lists in-person verification options, and authorized representatives must also provide a copy of their appointing document.
- Can I request copies instead of inspecting records?
- Yes. The application offers in-person inspection, paper copies, or an electronic copy. It states that paper copies cost $0.25 per page, payable before the records are provided.
- Can I use a remote online notary?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c, effective in 2023. Ask Erie County whether it accepts a remotely notarized mailed application.
- What if I am unsure which verification method applies?
- The form distinguishes mailed requests from in-person requests and describes verification options for each. Confirm with the city, town or village if unsure; for this county form, contact Erie County.