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INDIAN RIVER COUNTY HEALTH DEPARTMENT FEE SCHEDULE !Mogg . � :..Y , . Q% -` . 179 3: O , ._ r ESQ =;D} , , „ = E CY 1243 IN-HOUSE LAB LAB $0.00 $4. 25 $8.25 $12. 50 $16, 751 $20. 75 $25. 00 $25. 0 LAB $0.00 $5.95 $ 11 .55 $17. 50 $23,451 $29,051 $35. 00 $35.0 NOTE : Tests which exceed a charge of $100.00 will be billed individually on a sliding fee scale percents a based on IRCHD cost of lab service IN-HOUSE and CONTRACTED LAB Fee is for all labs performed at the time of service. All Lab fees will be charged in addition to office visits on a sliding fee scale as above. General Health Consultation - private facilities and agencies $55.0 Smoking Cessation - group setting $25.0 per client Notary Public Fee $15. 0 Return Check Service Charge $ 15.00 or 5% of the face amount of the check, draft or order, whichever is greater not to exceed $150. 00. (S. 215.34(2), F.S.) I (DOHP 56-66 08 - AR Policy) Special reports (Physician's narrative, insurance forms, or review of medical records by physician $25. 0 Copy of Medical Record/per page $0. 15 per page and an additional $.05 for double sided copies plus cost of postage if mailed. Large scale copying requets requiring extensive clerical assistance will be subject to an $ 10.00 administration fee in addition to the above stated fee per FL Statute 119.07, NOTE: Florida Statutes regarding release of medical records must be met prior to release of medical records to any source. No fees are charged to physician offices/other medical agents with the understanding that IRCHD will also be exempt from such payment. ' ha 1 Se fThe charges to clients for all items purchased by and under the purview of the Health Department shall be predicated upon the basis of actual costs plus $10.00 fee for each item purchased on a sliding fee basis. Insulin and Epilepsy medications can be provided at no charge if residents r meet financial screening eligibility criteria. tal Sts F CY 12=13 Birth Certificates (computer) $ 12.00 Birth Certificates (book) $15. 00 Additional Copies (computer) $10. 00 Additional Copies (book) $10.00 Death Certificates $ 12.00 Plastic Sleeve $5.00 Research Fee (per year) $3.00 Expedite Fee $5. 00 Overnight Shipment $15.00 Birth Certificates are provided free of charge to the following only: Children i£ Families Case Workers who are involved in a custody case. Case Worker must present proper ID, completed application request and copy of the signed court petition . Only one certified copy will be provided per six (6) month period. Page 5 of 9