Rescue Transport Report Request

Attorneys

Mail the subpoena or records request with HIPAA release to:

City of Hollywood Fire/Rescue, Attn: Medical Records Custodian,

2741 Stirling Road, Hollywood, FL., 33312-6505


To request  digital records www.ChartSwap.com and use HOLLYWOOD EMS.


Attorneys or patients sending a payment include the account number/patient name.

Mail to City of Hollywood Fire/Rescue, Attn: Billing,

2741 Stirling Road, Hollywood, FL., 33312-6505.


Hospitals, Medical Examiner, Police Departments. or other Govt. entities:

Contact Fire Rescue EMS Division 954.967.4248


Patients

Complete the appropriate 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.


Forms:

Request for Disclosure of Health Information

Hardship Request


 For Billing Disputes, Statements, 
Hardship:

Change Healthcare Office: 1.800.226.1012 
 Fax: 305.591.4660