Providence Fire Prevention Division
“Smoke Detectors save Lives”
Providence Fire Department
Public Safety Complex | 325 Washington Street, Providence, Rhode Island 02903
401-243-6050 ph | 401-243-6487 fax
www.providenceri.com
Request for Rescue Run Report
To: Providence Fire Department
Attn: Rescue Run Reports
325 Washington Street
Providence, RI 02903
From: _____________________________ Contact: _______________________
_____________________________
_____________________________
Please provide the following information in order to process your request:
Client Name: ______________________________________
Date of Birth: ______________________________________
Date of Incident: ______________________________________
Time of Incident: ______________________________________
Location of Incident: ______________________________________
□ 1
st
Page of Police Report or Incident Report (Required if a Report was made)
□ City of Providence’s “Patient Authorization for Use and Disclosure of Protected
Health Information” (We only accept our own Medical Release)
□ $10.00 check payable to “Providence Fire Department”
□ Self-addressed stamped envelope (Rescue Reports cannot be faxed)
□ For sign affidavit only, self-addressed stamped envelope & $3.00 check
For Billing inquiries please contact:
COMSTAR, INC.
8 Turcotte Memorial Drive
Rowley, MA 01969
(800) 488-4351
