(1) Prepare a paper request letter that is signed by the patient, notarized, and dated stating following:
My name is (INSERT PATIENT NAME) and my date of birth is (INSERT DATE OF BIRTH). I am requesting my own medical record(s) which may contain Protected Health Information. I believe I was evaluated by Lehigh EMS on or about (INSERT DATE OF ENCOUNTER). Please send copies of any applicable records to (INSERT YOUR MAILING ADDRESS). Payment is enclosed.
Note: the parent of a minor, a healthcare power of attorney, or other authorized person may accordingly modify the above text as appropriate. Supporting documentation must be included to substantiate this.
(2) Enclose a check or money order (no cash) for $5.00 (five US Dollars)
Fees are collected to cover the cost of certain labor, supplies, and postage as allowed per guidance from the US Dept of Health & Human Services
(3) Send your notarized request letter via US Mail or courier service to:
Lehigh University EMS - Records Unit, 4 Farrington Square #6801, Bethlehem PA 18015
(4) Your request will be responded to with the information you requested or reason(s) why your request could not be furfilled.
Emergency Medical Services
4 Farrington Square
Bethlehem, PA 18015
Lehigh EMS is a state-licensed Quick Response Service. Basic Life Support services are provided 24/7 when classes are in session. All EMS crews are staffed by volunteer students, faculty, and/or staff.
Report an on-campus medical emergency by calling the Lehigh University Police Department at 610-758-4200. Off-campus emergencies should be reported by calling 911.
27 Memorial Drive West, Bethlehem, PA 18015