Records & Privacy


All requests for Patient Care Reports require the actual patient to report to EMS Headquarters to complete a Records Release Form and present a valid government-issued picture identification of the patient listed in the report when picking up a report. If you are not the patient listed in the report, see below for authorized persons other than the patient permitted to receive patient records.

Patient Care Reports may also be sent to the requestor by contacting our Custodian of Records and requesting a Records Release Form which must be returned fully completed and accompany a copy of your government-issued picture identification.

Release of Records to Others

Consent for the release of confidential and protected health information must be in writing and signed by the patient, a parent or legal guardian if the patient is a minor, a legal guardian if the patient has been adjudicated incompetent to manage the patient’s personal affairs, and attorney ad litem appointed for the patient, or a personal representative if the patient is deceased. The written consent must specify:

1.  The information or records to be covered by the release

2.  The reason or purpose for the release; and

3.  The person to whom the information is to be released.

The patient or other person authorized to consent to the release of any information by submitting a written notice of withdraw to the person or program to which consent was provided. Withdraw of consent does not affect any information disclosed before the date on which the written notice was received.


This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Purpose of this Notice

The City of La Porte EMS is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information (PHI), and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. This Notice describes your legal rights, advises you of our privacy practices, and lets you know how the City of La Porte EMS is permitted to use and disclose PHI about you.

The City of La Porte EMS is also required to abide by the terms of the version of this Notice currently in effect. In most situations, we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written permission if we are required by law to do so.


If you have any questions, contact Capt. Trudy Rayburn, HIPAA Compliance Officer, by email, by phone at 281-470-0060 or visit:

La Porte EMS Headquarters
10428 Spencer
La Porte, TX 77571

  1. Other Services
  2. Use Without Authorization
  3. Uses & Disclosure
  4. Patient Rights
Information on Other Services
We may also contact you to provide you with other information about services we provide or other health-related benefits and services that may be of interest to you.