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Medical Records Request

Patients treated by Lehigh EMS may request a copy of their own Patient Care Report via the following procedure:

(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.