Requesting Medical Records

Your Privacy Comes First


Patients, or their legal representatives, may inspect and/or obtain a copy of their medical records. Acadian Ambulance requires a completed and signed Authorization for Use and Disclosure of Protected Health Information before releasing any documents to anyone, including the patients.

To request medical records or pay for previously requested records, please read the instructions below.

How to request a copy of your medical records

Print and complete the Authorization for Use and Disclosure of Protected Health Information.

The release form must be completed, dated and signed. For further instruction click here.

Email form to:

Mail form to:
Acadian Ambulance Service, Inc.
P.O. Box 98000
Lafayette, LA 70509
Attn: Medical Records Dept.

Fax form to:
Attn: Medical Records: Release of Information


In Person:
2916 N. University
Building G
Lafayette, LA 70507

Monday – Friday, 8:00 a.m. – 4:00 p.m. CST
Closed on holidays

Click below to pay for requested medical records.

NOTE: You must have a copy of the medical records pre-payment invoice in order to make a payment.

Medical Record Payments