Name* Phone Number Fax Number Company Street Address City State Zip Code Email * Please: Mail report Hold report for pick-up Fax report Email report TYPE OF REQUEST * Building/House Fire Vehicle Fire HazMat Data & Stats Other REQUEST DETAILS (Please be specific and, if applicable, include date, time, and incident location) Emergency Medical Service (EMS) records should include a Health Insurance Portability and Accountability Act (HIPAA) authorization form completed and signed by the patient or their legally authorized representative. Template forms are available at https://www.fairfaxcounty.gov/HIPAA/Pages/AuthorizationForm.aspx. A completed form can be submitted via email to fire.foia@fairfaxcounty.gov or sent via fax to 703-246-6096.
