Privacy & Medical Release


  • 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.