Request for PHI – Representative of Patient

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

If you are the patient, an attorney, or from another agency and are requesting Protected Health Information/Medical Records please visit the Request Medical Records for Ambulance Services page.