Mehlville Fire Protection District

How to Obtain a Patient Care Report

The Privacy Officer or such person he has designated will act upon a request for a patient care report within 30 days of the request. Upon completion of Mehlville Fire Protection District Form PR-4.A and providing the required identification for access, the requester will be provided a copy of the requested medical record. A request can be mailed to:

Mehlville Fire Protection District
Attn: Patient Care Report Request
11020 Mueller Road
St. Louis, Missouri 63123

If you are the patient:

You may order the report at Mehlville Fire Protection District Headquarters, 11020 Mueller Road. The MFPD representative will process your request from Form PR-4.A and verify your identity with a state driver's license or state identification card with a photo.

If the patient is a minor:

And you are a parent, guardian, or other person acting with legal authority (court order documentation must be provided) to make health care decisions on behalf of the minor child, the MFPD representative processing your request on Form PR-4.A must verify the requester's identity with a state driver's license or state identification card possessing a photo.

If the requester is the patient's personal representative:

Or some other person who is authorized to act on behalf of the patient in making decisions related to health care, in addition to Form PR-4.A, the requester must provide MFPD with documentation establishing authority to act on behalf of the individual with authority to access the medical record (for example, a Health Care Power of Attorney or similar proxy or a court order appointing the person to serve in a legal capacity), as well as provide MFPD with a state driver's license or state identification card possessing a photo verifying the requester's identity.

If a requester is a family member or another requester for a medical record regarding a deceased patient:

The requester must provide MFPD the request on Form PR-4.A, along with a certified copy of a death certificate, verification of authority as executor or administrator of the deceased individual's estate, as well as a state driver's license or state identification card possessing a photo verifying the requester's identity.