Medical Records Requests

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For information on how to submit a medical records request, please select your representation from the following list:

• Patient / Patient Representative
• Attorney
• Law Enforcement / DCF
• Organ & Tissue Bank / Medical Examiner
• HUD

Patients:

Patients who would like to request access to their Protected Health Information/Medical Records may contact Ambulance Billing Customer Service Department at (727) 582-2008.

Patients can mail or fax in their request. The Request for PHI Patient Form will need to be completed in its entirety and return to the address provided.

Ambulance Billing Customer Service
Phone: (727) 582-2008

Fax: (727) 582-2021
P.O. Box 31074

Tampa, FL 33631-3074

Patient Representatives:

Patient Representatives who would like to request access to Protected Health Information/Medical Records must fill out a Request for PHI Patient Representative Form in its entirety and supply the required documentation. Request for PHI Patient Representative documents may be mailed or faxed.

For questions regarding Requests for PHI by a Patient Representative, please contact a Billing Services - Legal agent.

Ambulance Billing Services - Legal
Phone: (727) 582-2052

Fax: (727) 582-2021
P.O. Box 31074

Tampa, FL 33631-3074

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Attorneys:

Effective November 1, 2019, EMS Management & Consultants (EMS|MC) will be fulfilling Records Requests and Subpoenas for medical records electronically via ChartSwap . ChartSwap is a HIPAA compliant platform launched to facilitate electronic medical and billing record exchange between medical providers and law firms. It is free to register and requestors can use ChartSwap to request, track, pay, and download records.

If you need assistance setting up ChartSwap or have a question regarding the processing of a records request or subpoena, please call (877) 414-0279.

HIPAA Authorization Form

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Law Enforcement / DCF:

Please utilize the form supplied and complete on your agency letterhead. This form may be faxed or mailed to the Pinellas County Ambulance Billing location.

Law Enforcement Records Request Form

DCF Records Request Form

For questions related to Law Enforcement or DCF requests, please contact a Billing Services - Legal agent.

Ambulance Billing Services - Legal
Phone: (727) 582-2052
Fax: (727) 582-2021
P.O. Box 31074

Tampa, FL 33631-3074

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Organ & Tissue Bank / Medical Examiner:

Records requests made by Organ & Tissue Banks or the Medical Examiner can be sent by fax to:

Ambulance Billing Services - Legal
Fax: (727) 582-2021

For questions related to Organ & Tissue Bank requests or Medical Examiner requests, please contact a Billing Services - Legal agent at (727) 582-2052.

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HUD:

For entities who are looking to verify information for patients under a program of the U.S. Housing and Urban Development (HUD), please supply your properly executed HIPAA authorization, or complete our HIPAA compliant form provided, and fax to:

Ambulance Billing Services - Legal
Fax: (727) 582-2021

For questions related to HUD verifications, contact a Billing Services - Legal agent at (727) 582-2052.

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