772.569.5309

Fax

Vero Beach - 2750 Indian River Blvd
Sebastian - 13397 U.S. 1
Fort Pierce - 828 S US Hwy 1

Patient Forms

Download and Print

Our policy is consistent with the following state regulations:

0507 395.301(4), F.S. (4) A licensed facility shall make available to a patient all records necessary for verification of the accuracy of the patient’s statement or bill within 10 business days after the request for such records. The records must be made available in the facility’s offices and through electronic means that comply with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. s. 1320d, as amended. Such records must be available to the patient before and after payment of the statement or bill. The facility may not charge the patient for making such verification records available; however, the facility may charge its usual fee for providing copies of records as specified in s.


395.3025. 0508 395.301(5) F.S. & 59A-3.256(3) F.A.C. 395.301(5) Each facility shall establish a method for reviewing and responding to questions from patients concerning the patient’s itemized statement or bill. Such response shall be provided within 7 business days after the date a question is received. If the patient is not satisfied with the response, the facility must provide the patient with the contact information of the agency to which the issue may be sent for review. 59A-3.256(3) Itemized statement or bill. The hospital shall provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian. The itemized statement or bill shall be provided within 7 business days after the patient’s discharge or release, or 7 business days after the request, whichever is later. The itemized statement or bill must include: (a) A description of the individual charges from each department or service area by date, as prescribed in subsection 395.301(1)(d), F.S.; (b) Contact information for health care practitioners or medical practice groups that are expected to bill separately based on services provided.


Please reach out to our billing department if you have any questions or concerns.

Request Appointment

Fill out the form below, and we will be in touch shortly.
Are you a new or returning patient?
Contact Information
Sex