Records Request

Patient Request for Access

As a patient, you have a number of rights with respect to your PHI, including:

Right to access, copy or inspect your PHI
You have the right to inspect and obtain a paper or electronic copy of most of the PHI that we collect and maintain about you. You also have the right to request that we transmit your PHI to a third party. Requests for access to your PHI or to transmit your PHI to a third party should be made in writing to our HIPAA Compliance Officer, and by filling out an access request form.

Right to request an amendment of your PHI
You have the right to ask us to amend PHI that we maintain about you. Requests for amendments to your PHI should be made in writing and you should contact our HIPAA Compliance Officer if you wish to make a request for amendment.

Right to request an accounting of certain disclosures of your PHI
You may request an accounting of certain disclosures of your PHI. Pro EMS will provide an accounting of those disclosures that we are required to account for under HIPAA. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact, our HIPAA Compliance Officer and make a request in writing.

Right to request restrictions on uses and disclosures of your PHI

You have the right to request that we restrict how we use and disclose your PHI for treatment, payment or healthcare operations purposes, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, we are only required to abide by a requested restriction under limited circumstances, and it is generally our policy that we will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or disclosure of your PHI, you should contact our HIPAA Compliance Officer and make a request in writing.

Right to notice of a breach of unsecured PHI
If we discover that there has been a breach of your unsecured PHI, we will notify you about that breach by first-class mail dispatched to the most recent address that we have on file. If you prefer to be notified about breaches by electronic mail, please contact our HIPAA Compliance Officer, to make Pro EMS aware of this preference and to provide a valid email address to send the electronic notice.

Right to request confidential communications
You have the right to request that we send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). If you wish to request that we communicate PHI to a specific location or in a specific format, you should contact our HIPAA Compliance Officer and make a request in writing.

Patient Request for Access to PHI Form

Non-Patient/Attorney Requests

We understand that patients may turn to the courts after an accident, and Pro EMS can assist law firms and record retrieval companies in obtaining the documents needed to further a legal claim. Pro EMS can provide copies of patient statements related to Ambulance Transport billing and copies of Patient Care Reports.

REQUIRED INFO

If your firm requires a document from us, please compile the following information on a Patient Authorization (to release records) Form that is signed by the patient and dated:

  • the patient name
  • the name of the Transporting Ambulance Service
  • the date(s) of service
  • your client’s date of birth
  • and the last four digits of their social security number

CHARTSWAP

Pro EMS utilizes ChartSwap, a web utility that allows us to exchange billing documents, affidavits, etc. via the Internet. Electronically transmit your request to us via ChartSwap. You may access an existing account or create a new account using the ChartSwap link  below.

 

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We understand that, in some cases, original copies of an affidavit or deposition are required for
filings. For any document that requires a notarial citation, your law firm may choose from a series of
delivery options: electronic delivery, delivery by mail, or both. When initially submitting your request,
choose the appropriate delivery method, and we will charge you accordingly.