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Attorneys
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 Fire Rescue & 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