To request patient information the following is required:
- Request in writing pertaining to Ambulance Records; include date of service, date of birth and patient’s name.
- HIPAA/Medical Release Form (if not the patient signature, please include Power of Attorney or Executor of Estate documents along with the Release Form).
All requests should be directed to:
Northlake Fire Protection District
c/o Paramedic Billing Service, Inc.
Pre-Legal Customer Service Department
395 W. Lake Street
P.O. Box 1368
Elmhurst, IL 60126
Phone: 630-903-2386
Fax: 630-903-2832
Please contact PBS with questions or for additional information.