- Home
- Departments
- Fire Rescue & Beach Safety
- Emergency Medical Services
- Rescue Transport Report Request
Attorneys
HARDCOPY VIA MAIL
City of Hollywood Fire/Rescue
Attn: Medical Records Custodian
2741 Stirling Road, Hollywood, FL., 33312-6505
ELECTRONIC www.ChartSwap.com and use HOLLYWOOD EMS
Patients Records Request
Mail to the address provided on the form with a copy of the patient’s & applicant’s government issued photo ID and if applicable a Power of Attorney and a copy of the Death Certificate.
Forms
Request for Disclosure of Health Information
Billing Disputes, Statements, Hardship
Change Healthcare Office: 1-800-226-1012 Fax: 305-591-4660
Payments for EMS Transport, Mail to Billing Lockbox
City of Hollywood & Beach Safety Department
P. O. Box 947121
Atlanta, GA 30394
Hospitals, Medical Examiner, Police Departments or other Gov’t. Entities
Contact Fire Rescue EMS Division 954-967-4248