EMS INFORMATION
Non-Patient/Attorney Requests
We understand that patients may turn to the courts after an accident, and AMFEMS can assist law firms and record retrieval companies in obtaining the documents needed to further a legal claim. AMFEMS can provide copies of patient statements related to Ambulance transport billing and copies of Patient Care Reports.
Required Information
If your firm requires a document from us, please compile the following information on a Patient Authorization (to release records) Form that is signed by the patient and dated:
the patient name
the date(s) of service
your client's date of birth
the last four digits of their social security number
Submit signed document to: recordsrequest@mcabilling.com
EMS Billing Rates
Anchorage Middletown Fire and EMS Rates Effective 11/01/2025 (approved by Board of Trustees 10/21/2025)
- BLS Non-Emergency: $2400.00
- BLS Emergency: $2750.00
- ALS Non-Emergency: $3000.00
- ALS Emergency: $3250.00
- ALS Level 2: $3750.00
- ALS Specialty Care: $4500.00
- Loaded Ground Mileage: $42.00
- Treat/No Transport: $150.00
Patient Rights and Requests for EMS Records
Patient Request Form for EMS Records
As a patient, you have several rights with respect to your PHI (Protected Health Information), including:
Right to access, copy or inspect your PHI
You have the right to inspect and obtain a paper or electronic copy of most of the PHI that we collect and maintain about you. You also have the right to request that we transmit your PHI to a third party. Requests for access to your PHI or to transmit your PHI to a third party should be made in writing to our HIPAA Compliance Officer, and by filling out a request form.
Right to request an amendment of your PHI
You have the right to ask us to amend PHI that we maintain about you. Requests for amendments to your PHI should be made in writing and you should contact our HIPAA Compliance Officer if you wish to make a request for amendment.
Right to request an accounting of certain disclosures of your PHI
You may request an accounting of certain disclosures of your PHI. AMFEMS will provide an accounting of those disclosures that we are required to account for under HIPAA. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact, our HIPAA Compliance Officer and make a request in writing.
Right to request restrictions on uses and disclosures of your PHI
You have the right to request that we restrict how we use and disclose your PHI for treatment, payment, or healthcare operations purposes, or to restrict the information that is provided to family, friends, and other individuals involved in your healthcare. However, we are only required to abide by a requested restriction under limited circumstances, and it is generally our policy that we will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or disclosure of your PHI, you should contact our HIPAA Compliance Officer and make a request in writing.
Right to notice of a breach of unsecured PHI
If we discover that there has been a breach of your unsecured PHI, we will notify you about that breach by first-class mail dispatched to the most recent address that we have on file. If you prefer to be notified about breaches by electronic mail, please contact our HIPAA Compliance Officer, to make Pro EMS aware of this preference and to provide a valid email address to send the electronic notice.
Right to request confidential communications
You have the right to request that we send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). If you wish to request that we communicate PHI to a specific location or in a specific format, you should contact our HIPAA Compliance Officer and make a request in writing.
Kentucky EMS Forms
Kentucky EMS Do Not Resuscitate (DNR) Form
Kentucky law forbids the EMS from recognizing any DNR request unless it's specifically spelled out on the "Kentucky Emergency Medical Services Do Not Resuscitate (DNR) Order". Furthermore, the original form should be accessible by EMS when arriving on the scene. If you do not wish for EMS to resuscitate a patient, please download the Kentucky State DNR form and fill it out following the supplied instructions. Without this form, we will have to do everything in our power to keep the patient alive. Keep in mind that this form is only applicable if you stop breathing or your heart stops beating.
It's also important to note that you must present EMS with the original, signed document—not a copy. (We suggest you make several originals so all concerned parties will have an actionable form).
If you need help filling out the form, we will be glad to assist you. Or if you don't have anyway to print out the document, contact us and we will have one sent to your home.
Kentucky MOST Form
The Medical Order for Scope of Treatment (MOST) form is a voluntary end-of-life planning tool designed to give those who are seriously ill or medically frail the opportunity to make their health care wishes known in the event they are unable to speak for themselves. The MOST form can be completed by a patient or their health care surrogate and must be signed by a doctor.
Additional information can be found at www.kymost.org