"General Records Request Form" - Alabama

General Records Request Form is a legal document that was released by the Alabama Department of Public Health - a government authority operating within Alabama.

Form Details:

  • Released on February 1, 2019;
  • The latest edition currently provided by the Alabama Department of Public Health;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Alabama Department of Public Health.

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ALABAMA DEPARTMENT OF PUBLIC HEALTH
OFFICE OF EMS
RSA Tower, 201 Monroe Street, Suite 1100
Mail to
: P.O. Box 303017 Montgomery, AL 36130-3017
General Records Request Form
Please use this form to submit all requests for records to the Office of Emergency Medical Services.
Public requested items will be processed once payment is received.
Please allow a minimum of two weeks for processing.
If requesting records that contain Protected Health Information, in addition to this form, please complete the
Authorization for Release of Protected Health Information form.
Requester Information
Requester Name:
Requester Address:
(Printed records and/or invoices will be mailed to this address)
E-mail Address:
Phone Number:
Description of Requested Information
Proposed Use of Records
(The Alabama Open Records Act and related case law allows state agencies to require that a reason be provided to show a
direct, legitimate interest in the specific document(s) requested. Your statement should communicate a direct interest in the
specific records requested (i.e. “I am a student doing a paper on…”) and should not be general statements of entitlement
(i.e. “I am a Taxpayer” or “It is a public document.”)).
Acknowledgement
I have read the instructions and agree to the terms and conditions stated herein, including the
requirement for advance payment of the final costs prior to production of the requested documents.
Signature of Requesting Party
Date
Print Name
The Office of EMS recognizes and supports the public’s right to inspect and request copies of public
records in accordance with state law. Some public records are available on the OEMS website:
www.alabamapublichealth.gov/ems. Please view the website prior to submitting a request for
records as your request may be satisfied by the information contained therein.
Office Use Only
Date Received:
Approved:
Denied:
Date Reviewed:
Page 1 of 2
02.01.2019
ALABAMA DEPARTMENT OF PUBLIC HEALTH
OFFICE OF EMS
RSA Tower, 201 Monroe Street, Suite 1100
Mail to
: P.O. Box 303017 Montgomery, AL 36130-3017
General Records Request Form
Please use this form to submit all requests for records to the Office of Emergency Medical Services.
Public requested items will be processed once payment is received.
Please allow a minimum of two weeks for processing.
If requesting records that contain Protected Health Information, in addition to this form, please complete the
Authorization for Release of Protected Health Information form.
Requester Information
Requester Name:
Requester Address:
(Printed records and/or invoices will be mailed to this address)
E-mail Address:
Phone Number:
Description of Requested Information
Proposed Use of Records
(The Alabama Open Records Act and related case law allows state agencies to require that a reason be provided to show a
direct, legitimate interest in the specific document(s) requested. Your statement should communicate a direct interest in the
specific records requested (i.e. “I am a student doing a paper on…”) and should not be general statements of entitlement
(i.e. “I am a Taxpayer” or “It is a public document.”)).
Acknowledgement
I have read the instructions and agree to the terms and conditions stated herein, including the
requirement for advance payment of the final costs prior to production of the requested documents.
Signature of Requesting Party
Date
Print Name
The Office of EMS recognizes and supports the public’s right to inspect and request copies of public
records in accordance with state law. Some public records are available on the OEMS website:
www.alabamapublichealth.gov/ems. Please view the website prior to submitting a request for
records as your request may be satisfied by the information contained therein.
Office Use Only
Date Received:
Approved:
Denied:
Date Reviewed:
Page 1 of 2
02.01.2019
ALABAMA DEPARTMENT OF PUBLIC HEALTH
OFFICE OF EMS
RSA Tower, 201 Monroe Street, Suite 1100
Mail to
: P.O. Box 303017 Montgomery, AL 36130-3017
Instructions for Requesting Public Records
Alabama law makes public records available for inspection and/or copy by its citizens, subject to
exceptions specified by law (§36-12-40 and 41, Code of Alabama, 1975, as amended). These
exceptions generally direct that certain information is privileged or confidential and shall not be
disclosed. In the interest of efficiency and conservation of time, the following procedure has been
established for requesting inspection and/or copy of public records that are within the jurisdiction of
the Office of Emergency Medical Services (OEMS).
READ THESE INSTRUCTIONS BEFORE PROCEEDING WITH YOUR REQUEST.
1. Complete the "GENERAL RECORDS REQUEST FORM" and submit it to the OEMS as follows:
Alabama Department of Public Health
Office of EMS
P.O. Box 303017
Montgomery, AL 36103-3017
2. Upon receipt of the completed General Records Request Form, the OEMS will provide a prompt
acknowledgment of receipt of the request, to include any deficiencies, such as, but not limited to: a
vague, non-specific request, an improperly completed form, or records not maintained by the OEMS.
As soon as the records are located and assessed for costs, an itemized invoice of the production cost
will be provided to the requesting party. Upon receipt of the estimated production cost, the OEMS will
begin production of the documents. No records will be made available to the requesting party until the
OEMS receives payment of the total costs set forth on the invoice. The OEMS will attempt to comply
with all requests within two weeks of receipt of final production cost. The following are the detailed
costs involved in processing general records requests through the OEMS:
Retrieval Fee: $5.00
Black & White pages: $1.00 per page for the first 25 pages
$0.50 per page after 25
3. Payment for production cost shall be made by cashiers' check, money order, check, or cash only
and must be received by the OEMS before any copies are produced. It is recommended that cash
payments are not sent by mailThe OEMS will provide a receipt with the documents when produced.
4. The completed General Records Request Form must be mailed to the post office box listed above,
hand delivered to the OEMS, emailed to emsinquiry@adph.state.al.us, or faxed to 334-206-0364.
Requests by telephone will not be accepted.
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02.01.2019
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