Please provide a detailed description of the records you are requesting. In order to expedite the search for the records, please be as specific as possible.
NOTE: If you are requesting an EMS report, all requests for EMS records must be submitted directly to Medicount Patient Relations. Please call (513) 612-3154 or send an email to firstname.lastname@example.org
This field is not part of the form submission.
* indicates a required field