Patient Care Report and Itemized Billing Statements
Please refer to instructions below as it applies to your request to avoid incomplete request being subject to denial.
If your Client has been treated in Kansas City, Kansas, requests submitted for legal purposes must include a cover letter on your company’s letterhead. Information to Include is below. Requests for Patient Care Report, Itemized Billing Statements or BOTH should be mailed together to the address below including payment fee.
BY MAIL requests must include applicable fees and proper documentation at time of submittal.
BY FAX accepted with proper documentation at time of submittal. Payment fee must be postal stamped and received within 10 days of the date stamp on fax.
INFORMATION TO INCLUDE
Address of the Incident to include City/State
Date of the Incident
Date of Birth
Death Certificate (when applicable)
Name (alias, forename, hyphenated, maiden, married, etc.)
Release of Authorization signed and notarized
Social Security Number
Make Check Payable to Wyandotte County Treasurer
Address Envelope to:
Kansas City Kansas Fire Department
Attention: Medical Records
815 No. 6th Street
Kansas City, KS 66101
FAX: 913-551-0490, Attention: Medical Records
PAYMENT FEES (personal check – money order – cashier’s check)
Patient Care Report and Itemized Billing Statement – $5.00
Patient Care Report (only) – $5.00
Itemized Billing Statement (only) – No Charge
Patient may request a copy of their Patient Care Report by completing the Request for Inspection or Copy of Health Information, provide photo I.D. and payment fee. Bring in person to the Kansas City Kansas Fire Department Monday through Friday, 9 a.m. to 4 p.m.
It is the responsibility of the requestor to provide incidents number(s) for patient records prior to 2017.
Questions related to Ambulance Billing please call customer service of our billing contractor EMERGENCY MEDICAL SERVICE BILLING at 1-888-980-9136.
**Attorneys may request Itemized Bill while obtaining a Patient Care Report following the above procedures.