Manchester, Connecticut

Incident and Patient Care Reports

REQUESTING A FIRE / (Non-Medical) INCIDENT REPORT
See below for Patient Care Report Requests

1. Completed Incident Report Request Form
2. A Fire Marshal office representative will contact you once your report is ready for pick-up or delivery via fax, e-mail or USPS.  Payment must be made prior to mailing.

PLEASE NOTE:  There is a report fee of $0.50 per page.  We will contact you with the final cost once the requested reports is/are completed.
 
If mailing, send your request to:
Manchester Fire-Rescue-EMS
Fire Marshal's Office
494 Main Street
Manchester, CT 06040
Fax: (860) 647-3073

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AUTHORIZATION TO RELEASE PATIENT CARE REPORT

If you were medically treated by personnel of Manchester Fire-Rescue-EMS (MFRE) Department, you, or an agent specified by you, have the right to obtain a copy of the Patient Care Report (PCR) that was generated. A copy of your PCR will be released provided:
 
[1] You, the subject (patient) of the PCR, appear personally in the Office of the Fire Chief of MFRE, complete an "Authorization to Release Medical Information" and be further prepared to offer current valid photo identification that establishes you are the patient referred to in the PCR, or
 
[2] You complete an "Authorization to Release Medical Information" and you, or your agent, forward a notarized original form to the Office of the Fire Chief of MFRE, or
 
[3] You, with Power of Attorney, complete an "Authorization to Release Medical Information" and forward a notarized original form to the Office of the Fire Chief of MFRE along with a copy of the Power of Attorney, or
 
[4] You, an adult with authority to act for a minor patient, complete an "Authorization to Release Medical Information" and forward a notarized original form to the Office of the Fire Chief of MFRE.
 
[5] Cash or check, made payable to Manchester Fire-Rescue-EMS, in the amount of $2.50 per report, to be received upon receipt of report.
 
Upon receipt of a properly completed Authorization to Release Medical Information the Keeper of Records will provide that a true copy of the requested PCR be produced within thirty (30) days.

Send your request to:
Manchester Fire-Rescue-EMS
Office of the Fire Chief
75 Center Street
Manchester, CT 06040
Fax: (860) 647-3268