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Welcome to Hughes County EMS on the web
Need one of our forms?
Need one of our forms?
Hughes County EMS is required by law to maintain the privacy of your health information, to provide you with a notice of our legal duties and privacy practices, and to follow the information practices that are described in the Notice of Privacy Practices which are listed below.
Hughes County EMS is required by law to maintain the privacy of your health information, to provide you with a notice of our legal duties and privacy practices, and to follow the information practices that are described in the Notice of Privacy Practices which are listed below.
As a patient, you have the right to access your medical records, you have the right to receive a copy of your health information that we maintain, with some limited exceptions. You have the right to receive a copy of your health information in a format you prefer (e.g., paper, email, CD, USB Drive, Fax{we are unable to process request on obsolete mediums including 3 and 5 inch diskettes}). You have the right to request that your health information be sent to any person or entity. Here you'll find instructions and a convenient form to help us process your request.
As a patient, you have the right to access your medical records, you have the right to receive a copy of your health information that we maintain, with some limited exceptions. You have the right to receive a copy of your health information in a format you prefer (e.g., paper, email, CD, USB Drive, Fax{we are unable to process request on obsolete mediums including 3 and 5 inch diskettes}). You have the right to request that your health information be sent to any person or entity. Here you'll find instructions and a convenient form to help us process your request.
Hughes County EMS is committed to collecting, maintaining and providing quality patient health information. Further, the agency is dedicated to:
Assuring the integrity of each patient's health information;
Providing information in an efficient manner; and
Protecting the confidentiality and security of said information
Hughes County EMS is committed to collecting, maintaining and providing quality patient health information. Further, the agency is dedicated to:
Assuring the integrity of each patient's health information;
Providing information in an efficient manner; and
Protecting the confidentiality and security of said information
Physician Certification Statement (PCS)
Physician Certification Statement (PCS)
Need our PCS form to set up an interfacility transfer? There are forms for both repetitive and non repetitive transports.
The repetitive form can only be signed by the patient's attending physician and is only good for 60 days after initial transport.
Non repetitive PCS is good for one- one way trip
Physician Written Orders form
Physician Written Orders form
Used with the PCS above to provide orders above and beyond agency protocols.
Physician Certification Statement (PCS) Instructions
Physician Certification Statement (PCS) Instructions
Instructions to fill out our PCS.
Request for Access to my PHI
Request for Access to my PHI
Need to access to your medical information? We follow HIPAA guidelines and require a release of information form to be filled out.
HIPAA Release of Information
HIPAA Release of Information
Need to release your medical information to a family member or attorney? We follow HIPAA guidelines and require a release of information form to be filled out.
HIPAA Accounting of Disclosure Form
HIPAA Accounting of Disclosure Form
Need to see how your medical records were disclosed by this agency?
HIPAA Amendment to Medical Record Request
HIPAA Amendment to Medical Record Request
Need to to request a change to your medical record?
Utilize the second form to tell us who gets an amended copy of your medical record
HIPAA Notice of Privacy Practices
HIPAA Notice of Privacy Practices
Need to see how your medical records will be used by the agency , any business associates, or otherwise disclosed?
HIPAA Release of Information Limitation, change in communications, or Revocation
HIPAA Release of Information Limitation, change in communications, or Revocation
Need to revoke or limit a previous release of your medical information form or change how we communicate PHI with you, then fill out and submit these forms
Access to a deceased persons medical records
Access to a deceased persons medical records
Need access to the medical records of a relative who passed away? Utilize this form for that request
Financial Hardship Form
Financial Hardship Form
Are you worried that you wont be able to pay your ambulance bill? Utilize this form to submit a hardship request.
Advanced Beneficiary Notice
Advanced Beneficiary Notice
An ABN is a written notice from Medicare (standard government form CMS-R-131), given to you before receiving certain items or services, notifying you:
Medicare may deny payment for that specific procedure or treatment
You will be personally responsible for full payment if Medicare denies payment
Processing Time of Request
Processing Time of Request
Please allow sufficient time for processing. Turnaround time is up to 15-60 days depending on the form and what federal law allows.
Cost
Cost
For medical use, there is no fee if records are to be sent directly to a doctor or other healthcare provider for the purpose of continuing care.
For copies for patients or their representatives, there may be a reasonable, cost-based fee which includes the median records are requested to be submitted on.
For copies for other uses, the current rates set by state law may apply.
Payment
Payment
Please follow the payment instructions on the invoice you receive with the records.
Language Services
Language Services
Hughes County EMS provides free language services to people whose primary language is not English.
Questions, Comments, or Concerns can be addressed to; or forms submitted via:
Questions, Comments, or Concerns can be addressed to; or forms submitted via:
In Person
In Person
Hughes County EMS
114 N. Oak Street, Holdenville OK 74848
Office Hours Monday - Thursday 8am - 5pm, Friday 8am - 12pm
Email
Email
Agency Privacy Officer:
Christopher Miller at cmiller@hcems.org
Mailed
Mailed
Hughes County EMS
Attn: Privacy Officer
PO Box 671
Holdenville, OK 74848
Fax
Fax
Hughes County EMS
Attn: Privacy Officer
405-379-7046
Frequently asked questions about obtaining medical records
Frequently asked questions about obtaining medical records
How do I request copies of my medical records?
How do I request copies of my medical records?
You may visit us at the address listed above under "In Person" and complete an authorization to have your records released.
I do not have transportation. How can I get an authorization form?
I do not have transportation. How can I get an authorization form?
A Hughes County EMS representative would be happy to mail, email, or fax an authorization form to you. You can request an authorization form by calling 405-379-7046 Mon - Thurs: 8 a.m.-5 p.m. and Fridays 8a.m. to 12 p.m. You can then mail, fax, or email the authorization back to us using the information above.
How long does it take to get copies of my medical records?
How long does it take to get copies of my medical records?
The normal processing time for fulfilling a request for medical records is 7-10 business days, we are required to respond by 30 days for most request and 60 days to amendment request.
What is the cost for copies of medical records?
What is the cost for copies of medical records?
The cost for medical records when a patient requests the information is currently $0.00 per page. The cost if the records are requested by your insurance company or an attorney is currently $0.00. The cost for delivery of medical records via CD is currently $0.00 in addition to the per page cost. The cost for delivery of medical records via USB is currently $0.00 in addition to the per page cost. The cost for the mailing of medical records is $0.00 in addition to the per page cost. There is no charge when records are requested by your physician.
How do I pay for my medical records?
How do I pay for my medical records?
When your request for medical records is complete, you will receive an invoice from Hughes County EMS by mail. The invoice will include the breakdown of the fees along with an address to where you should send the payment. You may also pay by credit card by filling out the appropriate field on your invoice. Your records will be mailed to you the same day the invoice is mailed out. If you would rather pick up your records, or have them emailed to you, please note your request on the authorization form.
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