Get Nv Records Request Form - Clark County 2022-2025

Filling out the NV Records Request Form for Clark County is essential for obtaining important records related to incidents. This guide provides clear instructions to help users complete the form accurately and efficiently, ensuring a smooth request process.

Follow the steps to complete the NV Records Request Form online:

1. Press the ‘Get Form’ button to access the NV Records Request Form. This will open the form in your designated editing platform.
2. Fill in the date of your request at the top of the form. This information is crucial for tracking your request.
3. In the 'Incident' field, briefly describe the incident for which you are requesting records.
4. Provide your name in the 'Requested By' section. Ensure this is accurate to facilitate communication.
5. If applicable, fill in the 'Company' field with your organization’s name.
6. Enter your telephone number and, if necessary, your fax number for further correspondence.
7. Include your email address to receive notifications and follow-ups regarding your request.
8. Select the type of incident relevant to your request by checking the appropriate box: Fire, Vehicle Fire, Medical, or Other.
9. Specify the date and time of the incident in the corresponding fields. Indicate whether the time is AM or PM.
10. If applicable, provide the address or intersection where the incident occurred.
11. If the incident involves a vehicle, include the relevant vehicle information.
12. For medical report requests, ensure that you complete the HIPAA release section, which may require notarized authentication and ID.
13. Fill in the patient's last and first name, along with their date of birth, ensuring accuracy.
14. Select the appropriate gender of the patient.
15. Provide the purpose of your report request in the designated field.
16. If you are not the patient, complete the 'Authorization to Use and Disclose Protected Health Information' form, ensuring it is signed and notarized.
17. Finally, review all information for completeness and accuracy to avoid delays. Save your changes, then download, print, or share the completed form as needed.

Complete your records request online today to ensure a prompt response.