Privacy & Medical Release

Resources

• Notice of Privacy Practices Form (PDF) - This document describes the Salem Fire Department's Privacy Policy.
• Medical Records Access Form (PDF) - If you would like access to your medical records, complete this form.
  • You must also bring a valid physical ID, to prove who you are (i.e. - Driver's License, State ID, U.S. Passport)
  • Completed forms can be sent to the Salem Fire Department by the following methods:
    • Mail to:
      Salem Fire Department
      Attn: Privacy Officer, 152 Main Street, Salem, NH 03079
    • Fax: 603-893-3789
    • Email Doug Devine
• Medical Billing Records - Please see the Billing Information page for medical billing for access to billing related to medical care.
• Legal Requests for Medical Records - You are able to use the form that is attached or refer to ChartSwap.