HIPAA Forms

• Authorization to Release Records
• Request to Access Records
• Request to Restrict Records
• Request to Ammend Records
• Complaints regarding personal health information

Finance
The Finance forms below are for Lake-Sumter EMS Employees use only.

• Admin Uniform Allotment
• Communications Uniform Allotment
• Deduction Form
• Field Uniform Allotment
• Issued Equipment Acknowledgement Form
• LSEMS 2005 Pay Calendar
• Manual Timesheet
• Missing Receipt Form
• Travel Request Form
• Travel Voucher Form
• Uniform Request Form