Incident Request Form

REQUESTING AN INCIDENT REPORT

Incident reports are considered public information and are available upon request. Please note the following when requesting a report.

    • Please allow 5-10 business days for processing your request. For records requiring extensive investigation, please allow 20-30 business days for processing.
    • All confidential information will be redacted from copies of public records.
    • The District can only provide medical records for procedures performed by North Collier Fire Control and Rescue District. For reports regarding ambulance transport to hospitals, please contact Collier County EMS at (239) 252-3740.
    • In order to streamline processing and to ensure accuracy, we ask that you submit your request in writing via mail, email, facsimile or hand delivery. Completed reports not containing medical records can be mailed, faxed, emailed or picked up. Due to privacy concerns, completed reports containing medical records will not be emailed or faxed.
    • Under Chapter 119 of the Florida Statutes, the public is entitled to access public records except documents meeting any of the exemptions identified in the Florida Statutes section 119.011(1).

INCIDENT REPORT WITHOUT MEDICAL RECORDS (Fire, Property, etc.)

Requests can be made by submitting an executed North Collier Fire Control & Rescue District Public Records Request Form (Without Medical Records), via mail, facsimile or hand delivery. You may also submit your request online.

The following information must be provided with your request.
• The exact date, time and location of the incident.

INCIDENT REPORT WITH MEDICAL RECORDS (Rescue Patient Report)

Requests can be made by submitting an executed North Collier Fire Control & Rescue District Public Records Request Form for Medical Records along with an executed Authorization Form. Completed forms should be emailed to Ramona Martinez at rmartinez@northcollierfire.com or faxed to (239) 597-7082. Please include proper identification as required by the Authorization Form.

Please note that the data contained on the rescue patient report is confidential medical information. It is exempt from Florida Statutes 119.0, Public Records Law, and protected under Florida State Statutes 401.30, Medical Transport Law and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Public Law 104-191, Privacy Rule 45CFR Part 160-1 64.

The following information must be provided with your request.
• The exact date, time, and location of the incident.
• Patient’s full name, including alias if applicable.
• If patient is a minor, the parent or legal guardian must provide legal documents stating guardianship or a birth certificate, along with a copy of the requesting parent/guardian driver’s license or legal photo ID.
• If you were the person treated by the District, include a copy of your driver’s license or legal photo ID with your request.
• If the requestor is a law firm or insurance company, a signed Authorization Form is required. If the patient is a minor, the parent or legal guardian must sign the authorization form and state the relationship to the minor.
• Attention Attorneys: If submitting a Non-Party Subpoena for Medical Records, please provide a courtesy copy of the Certificate of Non-Objection along with Subpoena to avoid delays. Please see Florida Rules of Civil Procedure 1.351.

FEE SCHEDULE

Incident Reports Without Medical Records

  • $26.00 Service Charge per Incident Report may apply
  • Mail: 15¢ per page plus postage
  • Pick-Up: 15¢ cents per page
  • Email: (no charge)
  • Fax: (no charge)
  • CD of On-the-Scene-Photos (if available): $10 plus postage

 
Incident Reports With Medical Records

  • Due to privacy concerns, completed reports containing medical records will not be emailed or faxed.
  • $26.00 Service Charge per Incident Report applies to all requests containing medical records and may apply to others at the discretion of the District
  • 15¢ per page (plus postage)
  • 15¢ cents per page (pick-up)
  • CD of On-the-Scene-Photos (if available): $10 plus postage
  •  
    Please note that any request that requires extensive use of information technology resources or clerical or supervisory assistance may be assessed an additional charge (special service fee) consistent with Chapter 119, Florida Statutes.