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, 2 Asa Drive Room 201, Bethlehem PA 18015