top of page

Requests for Medical Records


All patient care documents reports created by CCAD personnel during the performance of their duties are protected, private information and cannot and will not be released without proper identification and legal authorization by the patient or by orders of the court in the form of a search warrant or subpoena.


CCAD has provided a downloadable form: Authorization to Release Medical Records that must be completed and signed by the patient. The authorization directs CCAD to release and to furnish “Named Person or Company” all patient records and all related documentation with reference to the individual named herein. A copy of this authorization shall be as good as an original and will expire as noted in Section 7 of the form or until revoked in writing. Please mail your request to 911 Billing Services and Consultants. PO Box 589,  Madisonville, KY 42431. Additionally, you may email your request to  Your request will then be processed and can either be mailed to you via USPS or emailed to you via secure email. Please indicate which delivery method you prefer on the authorization form.


If obtaining records by Search Warrant or Subpoena in lieu of a patient’s signed authorization, a copy of the legal document must be presented and attached to the signed request. All requests by warrant or subpoena will be handled by the CCAD Compliance Manager.

bottom of page