EMS Report Requests

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EMS Patient Report Requests

The City of Helotes responds to EMS Report Requests within 15 business days of the initial request. A fee of $6.00 applies per EMS Report. A fee of $6.00 applies per affidavit. If applicable, additional fees for postage and supplies will also be assessed. The City Secretary’s Office will provide an itemized statement of charges to the requester. Payment and record retrieval is done at the Development Services (Permits) Department window inside City Hall.

EMS reports are only released to the individual within the report identified as the patient. Photo identification will be required to verify the patient’s identify when picking up the report.

If someone, other than the patient, will be picking up the report, then that individual must show a valid “Power of Attorney” or “Authorization Form” to allow the release of said records.

How to Request a Report

The City Secretary’s Office accepts written Fire/EMS Report Requests by the following methods:

Delivered in-person to City Hall located at 12951 Bandera Road
Sent by postal mail to City of Helotes, City Secretary – Records Request, PO Box 507, Helotes, TX 78023
Emailed to the City Secretary
Faxed to 210-695-2123
Click here to download the Authorization Form. A completed form will need to be 1) submitted with written request or 2) uploaded with the electronic Helotes EMS Report Request Form below.
Complete and submit the electronic Helotes EMS Report Request Form shown below.

EMS Billing Questions and Billing Record Requests

Billing statement inquiries should be directed to the City’s billing agency, Emergicon Emergency Medical Billing, by telephone at 1-877-602-2060 from 8:00 a.m. and 5:00 p.m. CST. The online payment system can be accessed by visiting www.emerigcon.com.

Emergicon uses ChartSwap for billing records and billing affidavit requests. To submit this type of request, visit www.chartswap.com.

Privacy Notice

Review the Helotes Fire/EMS Protected Health Information Notice to learn how medical information may be used and disclosed. In addition, learn how patients can receive access to this information.

Helotes EMS Report Request Form

Applicant Name: *

First

Last

Applicant Email: *

Applicant Phone Number: *

Company/Organization Name (if applicable):

Applicant Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Do you want a copy of the EMS report? (select one): *

Yes (Fees Apply)
Certified Document (Fees Apply)

Upload Completed Authorization Form: *

Click or drag a file to this area to upload.

See above for the link to access a copy of the Authorization Form.

Upload a Copy of Your Identification Card (ID): *

Click or drag a file to this area to upload.

For example, a picture state ID or driver's license.

Name of Patient: *

First

Last

Date of Service: *

Date

Time

Address of the Incident: *

Address Line 1

Address Line 2

City

State

Zip Code

Electronic Signature of Patient or Patient's Representative/Guardian: *

Use your cursor electronically sign this form.

Explain the Representative/Guardian's Relationship to the Patient (If the Patient is a Minor or Incapacitated Adult):

City Secretary

Celina Perez
City Secretary
12951 Bandera Road
Helotes, Texas 78023

Phone: 210-695-5911
Fax: 210-695-2123

Email City Secretary

EMS Report Requests

Quick Links

EMS Patient Report Requests

How to Request a Report

EMS Billing Questions and Billing Record Requests

Privacy Notice

City Secretary

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