Incident and Patient Care Reports

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REQUESTING A FIRE / (Non-Medical) INCIDENT REPORT

See below for Patient Care Report Requests

To complete a request, please click on the Freedom of Information (FOI) Request link below. This will bring you to an online form.

https://manchesterct.highq.com/manchesterct/renderSmartForm.action?formId=a0664f39-3352-44718e9b-840b0d35df2a

Please complete the required fields:

  • Name
  • Email address - if you do not have an email address, you can enter none@email.com but please note that you will be required to come into Town Hall to pay the fee and pick up the documents.
  • Phone number
  • Description of Request - please include specific details about your request.

Once your request is submitted, the following steps will occur to address your request.

  1. You should receive an email confirming that your request was received. If you do not receive the confirmation email, contact the Town Attorney's office at townattorney@manchesterct.gov.
  2. The appropriate department will review your request.
  3. Once the information is gathered, you will receive an email indicating the amount due for your request. The cost is $0.50 per page. You will pay this fee online using the link provided in the email.
  4. When your payment is received, the documents will be sent to your email.
  5. If you have any follow-up questions, please contact townattorney@manchesterct.gov.

AUTHORIZATION TO RELEASE PATIENT CARE REPORT

If you were medically treated by personnel of Manchester Fire Department (MFD), 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 MFD, 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 MFD, 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 MFD 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 MFD.
  5. Cash or check, made payable to Manchester Fire Department, 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(PDF, 9KB)  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 Department
Office of the Fire Chief
75 Center Street
Manchester, CT 06040
Fax: (860) 647-3268

NOTICE OF PRIVACY(PDF, 254KB)

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

Please note that patients can obtain billing information by calling 860-240-1818.

 

 

 

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