Request Medical Records for Ambulance Services

Patients, their representatives and certain members of qualified agencies may request protected health information and medical records maintained by Pinellas County.

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 must be completed and returned 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 complete the PHI Patient Representative Form and supply the required documentation. Request for PHI Patient Representative documents may be mailed or faxed to Ambulance Billing Services – Legal.

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


Attorneys

EMS Management & Consultants (EMS|MC) fulfills records requests and subpoenas for medical records electronically via ChartSwap. ChartSwap is a free HIPAA-compliant platform launched to facilitate electronic medical and billing record exchange between medical providers and law firms. 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 contact EMS Management & Consultants at 877-414-0279.

HIPAA Authorization Form


Law Enforcement

Law enforcement officials must complete the Law Enforcement Records Request Form and return it on your agency letterhead. This form may be faxed or mailed to the Pinellas County Ambulance Billing location.

For questions related to law enforcement 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


Department of Children and Families

Representatives of the Department of Children and Families must complete the DCF Records Request Form and return it on your agency letterhead. This form may be faxed or mailed to the Pinellas County Ambulance Billing location.

For questions related to Department of Children and Family 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


Organ & Tissue Bank or Medical Examiner

Records requests made by Organ and Tissue Banks or the Medical Examiner can be sent by fax to Pinellas County Ambulance Billing Services. For questions related to Organ and Tissue Bank requests or Medical Examiner requests, please contact a Billing Services – Legal agent.

Ambulance Billing Services – Legal
Phone: 727-582-2052
Fax: 727-582-2021


Housing and Urban Development

For entities who are looking to verify information for patients under a program of the U.S. Housing and Urban Development (HUD), please send your properly executed HIPAA authorization by fax to Pinellas County Ambulance Billing Services. You may also complete our HIPAA Compliant Form and return by fax. For questions related to HUD verifications, contact a Billing Services – Legal agent.

Ambulance Billing Services – Legal
Phone: 727-582-2052
Fax: 727-582-2021