Complete the Request for Disclosure of Health Information Form, mail to the address provided with a copy of the applicants photo ID, if applicable, a Power of Attorney, and a copy of the Death Certificate.
Billing Disputes, Statements, Hardship
Change Healthcare Office: 1-800-226-1012 Fax: 305-591-4660
Hospitals, Medical Examiner, Police Depts. or other Govt. entities:
Contact Fire Rescue EMS Division 954.967.4248
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
Payments for EMS Transport, Mail to Billing Lockbox
City of Hollywood & Beach Safety Department
P. O. Box 947121
Atlanta, GA 30394