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

Hardship Request

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