Patient Information is provided only in the form of our standard Patient Care Record (PCR). A PCR is only available to the patient, a legally authorized designee, or an agent in with appropriate documentation in an official investigation.
Patients, as well as parents or guardians of minor patients, may receive a copy of their patient care record (PCR) in person at the EMS business office at 120 S. Third St, Smithfield, NC.
Legal photo ID
Completed Authorization for Release of Patient Record form PDF (form may be completed in the office). Final signature must be done in the office.
Legal Designee of Patient may receive a copy of the PCR in person at the business office with a legal document granting authority. Family relationship does not qualify as legal designee of patient.
Legal photo ID
Legal document granting authority (Power of Attorney, executor of will/estate, death certificate, etc.)
Completed Authorization for Release of Patient Record form PDF. Final signature must be done in the office.
Alternatively, a designee may receive a PCR copy via mail by sending a Notarized Authorization for Release of Patient Record form via U.S. Mail and a photo copy of the legal document granting authority.
Law Offices may receive a copy of a PCR with a Notarized Authorization for Release of Patient Record form PDF. Law offices must use the Johnston County form. Releases created by the law office are not accepted. Law offices may pick up in person or via U.S. Mail. Faxes are not accepted.
Judge-Signed Papers (court orders, warrants, etc.) allow release of PCR without other documentation.
Johnston County EMS Business Office
PO Box 530
120 S. Third St.
Smithfield, NC 27577
Page last updated: March 6, 2023