Short Answer

In North Carolina, EMS patient care reports and billing records are protected health information. You generally need a signed HIPAA authorization from the patient to get them. If the patient cannot sign, a person with legal authority under North Carolina law (for example, a health care agent under a valid health care power of attorney, a court‑appointed guardian, or—if the patient is deceased—the estate’s personal representative) may authorize release. Without an authorization, you usually need a subpoena or court order.

Understanding the Problem

In North Carolina personal injury cases, can an attorney obtain a client’s EMS run report and billing records, and what authorization is required? Here, the EMS provider directed requests through a legal portal and warned that missing identifiers would delay processing.

Apply the Law

Under North Carolina law, EMS medical and billing records are treated as private health information. The baseline rule is a signed HIPAA‑compliant authorization from the patient. If the patient lacks capacity, a properly empowered decision‑maker may act. If the patient is deceased, the personal representative (appointed by the Clerk of Superior Court) becomes the decision‑maker for health information. If an authorization is unavailable or refused, records can be compelled in litigation with a subpoena issued under North Carolina Rule 45, or by court order, with required privacy safeguards.

Key Requirements

• Proper signer: The patient signs the HIPAA authorization; if the patient cannot, a valid health care agent or court‑appointed guardian may sign; after death, the estate’s personal representative signs.
• Valid scope: The authorization should expressly allow release of EMS medical and billing records for the specific dates of service.
• Provider intake details: Include the patient’s full name, date of birth, EMS provider name, request or portal tracking number, and (if available) the EMS run number and date of service to avoid delays.
• If no authorization: Use a subpoena duces tecum in a pending North Carolina case under Rule 45, or seek a court order with appropriate privacy protections.
• Special categories: Certain records (e.g., mental health or substance‑use treatment) may require heightened consent language or a court order.

What the Statutes Say

• North Carolina Rules of Civil Procedure, Rule 45 (Subpoenas) - Allows subpoenas to compel documents from nonparties with notice and protections.
• Health Care Powers of Attorney (Chapter 32A) - Identifies the health care agent’s authority to act for an incapacitated patient.
• Guardianship (Chapter 35A) - Courts may appoint a guardian and authorize access to medical records when needed.
• Estate Administration (Chapter 28A) - The personal representative, once appointed, acts for the decedent’s estate, including authorizing record releases.

Analysis

Apply the Rule to the Facts: Because EMS told you to use its legal portal and include identifiers, the cleanest path is a HIPAA authorization signed by your client. If the client lacks capacity, a health care agent or court‑appointed guardian can sign. If the client is deceased, wait for the Clerk of Superior Court to issue Letters to the personal representative, then submit the authorization signed by the personal representative. If an authorization is not available, plan to obtain the records with a Rule 45 subpoena once litigation is filed.

Process & Timing

1. Who files: Patient or patient’s attorney. Where: The EMS provider’s records/billing portal or legal department. What: Provider HIPAA form or your HIPAA‑compliant authorization; include patient name, DOB, provider name, request/portal number, and, if available, the EMS run number and date of service. When: Submit as soon as possible to avoid treatment or claim delays.
2. If signer lacks capacity: Use a valid health care power of attorney or obtain a guardianship order from the Clerk of Superior Court authorizing the guardian to access medical records; then re‑submit through the EMS portal. Timeframes vary by county.
3. If no authorization: After filing suit, issue a Rule 45 subpoena duces tecum from the court where the case is pending; serve the EMS custodian or registered agent and provide any required notices. Expect the provider to produce the run report and billing ledger after a reasonable compliance period or seek a court order if objections arise.

Exceptions & Pitfalls

• A general financial power of attorney may not authorize access to medical information unless it contains clear HIPAA release language; use a proper HIPAA authorization or a health care power of attorney.
• A health care power of attorney does not control after death; obtain Letters for the estate’s personal representative before requesting records for a decedent.
• Missing identifiers (name, DOB, provider name, request number, run number, date of service) commonly cause portal rejections or delays.
• Certain behavioral health or substance‑use records have extra consent or court‑order requirements; tailor your request language and be ready to seek a protective order.
• Pre‑suit subpoenas are generally not available; if you cannot obtain an authorization, plan to subpoena records after filing the action.

Talk to a Personal Injury Attorney

If you're dealing with an EMS provider and need medical and billing records for an injury claim, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at 919-341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.