AGENCY: Salt Lake City (Utah). Fire Department

SERIES: 81757
TITLE: Medical release records
DATES: 1978-1986.
ARRANGEMENT: numerical by assigned number

DESCRIPTION: These forms are completed when patient refuses care by fire Department or ambulance company personnel. In 1986, this form became part of the Emergency Medical Service Incident Report. They are used to verify the refusal of medical care. These forms include run number, reason for refusing treatment, affidavit for release of responsibility; name and signature of patient, name of EMT (emergency medical technician) or paramedic, date, signature of spouse, parent or legal guardian if patient is under 18, and signature of witness.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 05/1987

FORMAT MANAGEMENT

Paper: Retain in Office for 25 years and then destroy.

APPRAISAL

Administrative

This retention is based upon the administrative needs expressed by the department's fire surgeon. This form is part of the patient's medical history and should be maintained for at least 25 years.

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