In order to receive an EMS report, the requestor MUST be present at Station 1, 75 S 4th St, Newark, Ohio at the time of receipt. The requestor must have a photo ID and sign for the copy of the report. If you are not the patient, or can provide documentation that you are a legal representative of the patient, then you will receive a redacted copy of the report.
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    Name of requestor(required)

    Address of requestor(required)

    Requestor email (required)

    Phone number of requestor (required)

    Agency of requestor

    Name of patient (required)

    Date of occurrence (required)

    Date you would like to pick up the report (required)

    This request is in compliance with (state or federal law or regulation)

    Any additional information