Personal Medical Record Request
Requesting Your Own Records
If you were a patient transported by Acadian Ambulance and would like a copy of your own medical records (often called a “Run Log” or “Patient Care Report”), please follow the requirements below.
Required Items for Your Request
To verify your identity and protect your health information, we require two items to process your request:
1. Completed Authorization Form
The form must be signed and dated by you (the patient). Download the Authorization for Release form.
2. Valid Government-Issued ID
We must verify that the person requesting the records is the patient. Please provide a clear copy or photo of one of the following:
- State-issued Driver’s License
- State ID Card
- U.S. Passport
- Military ID
How to submit
You can submit your form and a copy of your ID via:
- Email: medicalrecords@acadian.com
- Please include the patient name and date of service in the subject line.
- Mail: Acadian Ambulance, Attn: Medical Records, P.O. Box 98000, Lafayette, LA 70509.
Important information for patients
- Continuing Care (Doctors’ Offices): If you need your records sent directly to a doctor or hospital for ongoing treatment, there is no charge. Please provide the doctor’s name, fax number, and address on the authorization form.
- Personal Use Fees: If you are requesting a copy for your personal records, a standard reproduction fee may apply. We will notify you of any costs before final processing.
- Billing Records: This request is for your medical chart only. If you need an itemized bill or insurance statement, please visit the Patient Billing Portal or call 337-291-4154.
- Delivery Format: You may choose to receive your records via secure email (PDF) or standard mail. Please specify your preference on the form.
Checklist before you send
- Did you sign the form?
- Did you include a copy of your photo ID?
- Is your current phone number and mailing address listed?
