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Pickens County Fire –Rescue Tim Prather, Fire Chief 1266 East Church St; Jasper, GA 30143 Phone: (706) 253-8944 Fax: (706) 253-9002 OPEN RECORDS REQUEST Policy and Procedures Release of Department Records All requests for reports must be submitted in writing. Requests must include the date and address of the incident location for a Fire Report and should include the patient’s name for PCR Reports. Any other report or record request must be specific. All record requests will be subject to a replication fee of 10 cents per page copied with a research fee equal to the hourly rate of the lowest paid person qualified to research the request after the first quarter hour. O.C.G.A.50.18.71.(c)(d). The requested report, record, summaries or compilations must be in existence at the time of the request. O.C.G.A.50.18.70(d). I. Fire Reports Any citizen of Georgia may obtain copies of fire reports which are defined as public record. Persons other than the property owner or renter of the property will be charged a replication fee of 10 cents per page for copies of requested documents. If the report is to be mailed, shipping charges will be applied. II. Patient Care Reports Per the Georgia Open Records Act, access to files that would be an invasion of personal privacy, including medical or similar records, will be refused, absent a showing of entitlement to the records (see criteria listed below) under O.C.G.A.50-18-72 Pickens County Fire-Rescue recognizes the information on a PCR Report as a medical record, subject to protection on the basis of privacy interest. To obtain replication of a PCR, one of the following criteria must be met, along with meeting the criteria for a Fire Report: 1. Request by patient (picture ID required); or 2. Request by next of kin, if patient deceased (picture ID required and copy of death certificate required); or 3. Request by individual possessing patient’s Power of Attorney (picture ID and notarized copy of Power of Attorney required); or 4. Request by parent or legal guardian if patient is a minor or incapacitated (picture ID and proof of relationship required); or 5. Request by attorney upon presentation of notarized medical authorization for release from patient; or 6. Presentation of valid subpoena for production of evidence or court order issued by a court of competent jurisdiction; or 7. Unobjected to Request for the Production of Documents in a filed civil action (lawsuit); or 8. Request by a Pickens County Law Enforcement Agency pursuant to an official criminal investigation (signed warrant or subpoena required). III. Other Records All other records requests must be specific in nature as to which records area sought. Charges for research and replication fees are applicable. ---PAGE BREAK--- Pickens County Fire –Rescue Tim Prather, Fire Chief 1266 East Church St; Jasper, GA 30143 Phone: (706) 253-8944 Fax: (706) 253-9008 RECORDS REQUEST FORM TODAY’S DATE: NAME OF REQUESTOR: REQUESTOR’S ADDRESS & PHONE ADDRESS OF INCIDENT REQUESTED: DATE OF INCIDENT: ARE YOU: (check one or more): VICTIM OWNER WITNESS ATTORNEY INSURANCE REPRESENTATIVE NEXT OF KIN MEDIA OTHER (Explain) REPORT(S) REQUESTED (check one) FIRE REPORT EMS/PATIENT CARE REPORT (if EMS report, must have one or more of the criteria in Section II of the PCFR Records Release Policy satisfied. Must also include a photocopy of the patient’s Photo ID) OTHER (explain) SIGNATURE OF REQUESTOR: SIGN