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Public Records Request

  1. MV Patch Logo_Black_Stroke_Final including Boarder
  2. Please describe the records you are requesting and any additional information that will help us locate them for you as quickly as possible. Failure to provide information sufficient to identify the records may cause delay.

    If you request medical records for a deceased "Decenent", WA State law (RCW 70.02.140, RCW 7.70.065) identifies a statutory priority among individuals with authority to consent to release a decedent's medical records. Before we can release the records to you, we need to confirm you are eligible. 

    Support Documentation/ Verification Needed:

    • Letters of Testamentary or Letters of Administration - If a personal representative is appointed for a descendant's estate, the medical records can only be released with the personal representative's authorization. Or,
    •  Durable Power of Attorney - If a descendant had durable power of attorney in effect at the time of death, the medical records can only be released to the attorney named under the power of attorney.
    • Surviving spouse or Family Member (Child, Grandchild, Niece, Nephew, Aunt, Uncle, or parent (who is 18+ years of age) - all surviving family members must agree to the consent of release. 

    By Signing this form, and requesting records for a dependent, the undersigned declares under penalty of perjury of the laws of the State of Washington that the above information and any submitted and attached documentation is true and correct.

  3. Descendant Options - Write-in the applicable descendant (Personal Representative, Guardian, Durable Power of Attorney, Spouce, Child (18+), Parent, Sibling (18+), Grandchild (18+), Niece or Nephew (18+), Aunt or Uncle (18+)
  4. Initial
  5. Initial
  6. I understand that there may be charges for duplication of these specific records. A minimum of $0.20 per page will be charged to the requestor. Further, the Districts Records Disclosure Policy is available for review.
  7. I realize that requesting records and not paying for the associated costs will mean that I must pay for them before the next request will be released.

    I certify that any lists of individuals obtained through this request for public records will not be used for commercial purposes.
  8. Pursuant to RCW 42.17.320, this form acknowledges that your request has been received. The District estimates that it will provide further response within 21 days or as soon thereafter as a determination regarding disclosure, denial, or an exemption can be established. The District does reserve the right to extend this time frame if necessary.
  9. Send Original Request to:
    Mountain View Fire and Rescue
    32316 148th Avenue SE
    Auburn, WA 98092
    Attention Records Request

    The public records officer will oversee compliance with the act but another Fire District staff member may process the request. Therefore, these rules will refer to the public records officer "or designee." The public records officer or designee and the Fire District will provide the "fullest assistance" to requestors; ensure that public records are protected from damage or disorganization; and prevent fulfilling public records requests from causing excessive interference with essential functions of the Fire District.
  10. RCW 70.02.060 Discovery Request or Compulsory Process
    (1) Before service of a discovery request or compulsory process on a health care provider for health care information, an attorney shall provide advance notice to the health care provider and the patient or the patient's attorney involved through service of process or first-class mail, indicating the health care provider from whom the information is sought, what health care information is sought, and the date by which a protective order must be obtained to prevent the health care provider from complying. Such date shall give the patient and the health care provider adequate time to seek a protective order, but in no event be less than 14 days since the date of service or delivery to the patient and the health care provider of the foregoing. Thereafter the request for discovery or compulsory process shall be served on the health care provider.

    (2) Without the written consent of the patient, the health care provider may not disclose the health care information sought under subsection (1) of this section if the requestor has not complied with the requirements of subsection (1) of this section. In the absence of a protective order issued by a court of competent jurisdiction forbidding compliance, the health care provider shall disclose the information in accordance with this chapter. In the case of compliance, the request for discovery or compulsory process shall be made a part of the patient record.

    (3) Production of health care information under this section, in and of itself, does not constitute a waiver of any privilege, objection, or defense existing under other law or rule of evidence or procedure.
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  12. This field is not part of the form submission.