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Request for Patient Records

Patient Medical Records

For patients treated and/or transported via ambulance by the BHFD, correlating patient medical records can be requested by the patient or his/her authorized representatives. Medical records are highly confidential under Federal and State law and thus, the BHFD must follow strict guidelines when releasing them. Said guidelines ensure that your medical records and protected health information (PHI) remain confidential.

A patient or authorized representative may request copies of medical records at no cost by following the instructions below:

-Complete both sides of the BHFD Authorization for Use & Disclosure of PCR.  If a patient is incapacitated or otherwise unable to sign the form and an authorized representative is acting on their behalf, the representative's relationship must be identified in section C. Official documentation proving the representative's legal authority to act and sign on the patient's behalf must be provided, such as a birth certificate (of minor patient), death certificate, or power of attorney.

-Include a photocopy of the signatory's valid and unexpired government-issued photo ID.  In lieu of a government-issued photo ID, a signature can be notarized.

-Submit the BHFD Authorization for Use & Disclosure of Patient Care Record (PCR) form and supporting documents to:

  • Email
  • Fax to (310) 278-2449, attn: EMS Records Custodian
  • Mail to BHFD, 445 N. Rexford Dr., Beverly Hills, CA 90210 Attn: EMS Records Custodian



Subpoenas for production of records can be served Monday-Friday from 8:00AM-5:00PM at Beverly Hills City Hall, 455 N. Rexford Drive, Beverly Hills, CA 90210.  


City Attorney, District Attorney, and Law Enforcement

Federal regulations, 45 CFR 164.512(f)(1)(ii) state that a release from the patient is not needed but a court order, warrant, subpoena, summons, administrative subpoena, or authorized investigative demand must be provided. In addition, a Law Enforcement Request for Protected Health Information form must be completed.

For Beverly Hills Police Department personnel requesting patient medical records, please complete the Request for Intradepartment PHI.

For assistance with medical records requests, please contact the Fire Administration office at (310) 281-2700.



For all other public records requests such as fire incident reports or inspection reports, please complete a Public Records Request Form and email to

  • City of Beverly Hills Shield
  • City of Beverly Hills
  • 455 North Rexford Dr
    Beverly Hills, CA 90210
  • (310) 285-1000
  • Monday-Thursday 7:30AM-5:30PM
  • Friday 8:00AM-5:00PM

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