EMS billing & Record Requests

If you are requesting a medical record for a patient treated and/or transported by Everman Fire Department, you must complete the Emergicon Authorization for Use or Disclosure of Protected Health Information found below. Please follow the step by step guidelines to complete your request. 

🧾 For Patients

• Billing Inquiries:
  If you have questions about your bill, please contact:
• Emergicon Customer Service
  📞 Phone: 972-602-2060 ext. 1610
• Medical Records Requests:
  To request medical records for a specific date of service, please complete the following form:
  📄 Patient Records Request Form (PDF)
• Once completed, submit the form along with a copy of your driver’s license via one of the methods below:
  • 📠 Fax (Secure): 800-608-9457
  • 📬 Mail: PO Box 180446, Dallas, TX 75218
  • 📧 Email: records [at] emergicon.com (records[at]emergicon[dot]com)
• Please ensure that both the completed form and a valid state-issued photo ID are included in your request.

⚖️ For Attorneys & Law Offices

• If you are unable to locate the ambulance provider in ChartSwap, we recommend contacting the provider directly.
• Record Requests:
  Submit all record requests via www.chartswap.com, listing the EMS agency as the Provider.

🩺 For Transplant Coordination, Tissue Donation, Crash Investigation, or Texas Trauma Registry Reporting

• If you are requesting records for purposes such as:
  • Organ or tissue donation
  • Crash reconstruction or investigation
  • Texas Trauma Registry submissions
  • Transplant coordination
• A member of our medical records team will contact you shortly.
• Please include the patient’s name, date of service, and any supporting documentation (if available) with your request.