EMS Billing

Pender EMS and Fire, Inc. does not handle patient billing in-house but contracts with a third-party billing company called EMS Management & Consultants.

If you have questions about a bill for EMS service, please call 844-239-6690.

Patient Care Records

Patient care records are considered confidential medical records and are protected by privacy laws. Please use the Authorization for the Disclosure of Protected Health Information Form to request records.

Patients and/or persons who are legally authorized to act on behalf of an individual may request a copy of their patient care record (PCR) in person at our headquarters station located at 805 Ridgewood Ave., Burgaw, NC 28425.

 

Required: 

  • Legal photo ID that also contains your signature (Driver’s License, State Issued ID, Military ID, Passport, or City/State/Federal Employment ID Card)

  • Completed Authorization for the Disclosure of Protected Health Information Form. Final signature must be done in the office. 

  • If patient is deceased, the original death certificate must be presented. We will make a copy of it and return it to you.

Alternatively, patients may request a copy of their PCR via mail by sending a Notarized Authorization for the Disclosure of Protected Health Information form via U.S. mail to:

                Pender EMS & Fire, Inc.

                Attn: Medical Records

                805 Ridgewood Ave.

                Burgaw, NC 28425

Legal Designee of Patient

All parents, guardians, and personal representatives must submit copies of official documentation evidencing their authority to act on behalf of the patient.

Required:

  • Legal photo ID that also contains your signature (i.e., Driver’s License, State Issued ID, Military ID, Passport, or City/State/Federal Employment ID Card)

  • Legal document granting authority (i.e., minor’s birth certificate, Medical Power of Attorney, Letters of Estate or Administration)

  • Completed Authorization for the Disclosure of Protected Health Information Form. Final signature must be done in the office. 

Alternatively, a designee may request a copy of their PCR via mail by sending a Notarized Authorization for the Disclosure of Protected Health Information form via U.S. mail to:

                Pender EMS & Fire, Inc.

                Attn: Medical Records

                805 Ridgewood Ave.

                Burgaw, NC 28425

Law Offices

Law Offices may request a copy of a PCR by submitting an Authorization for Release of Patient Record Form. 

  • Law offices must use the Pender EMS & Fire, Inc. form

  • Releases created by the law office are not accepted

  • Law offices may pick up medical records in person or request them to be sent via U.S. Mail

  • Faxed requests are not accepted

Judge Signed Papers

Judge-signed papers (court orders, subpoenas, warrants, etc.) allow for the release of patient care records without other documentation.