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INDIAN RIVER COUNTY HEALTH DEPARTMENT <br /> FEE SCHF <br /> X11 t3bir§I IN.S I ICBs a� 1,�n ' r i u' � 0°/a 'A •° 7i�° oB'�� 33°� �C, #�t�50°/gCfi PRd"" 671%a Eta " 83%0 M. J %Q:�G• CY 12-13 <br /> IN-HOUSE LAB <br /> LAB $0.00 $4.25 $8.25 $12.50 $16.75 $20.751 $25.001 $25.0 <br /> �orltaatedl�pbr�tgry€senrce�trer�Rey <br /> LAB $0.00 $5.95 $11.55 $17-501 45 $29.05 $35.00 $35.0 <br /> NOTE: Tests which exceed a charge of$100.00 will be billed individually on a sliding fee scale percentage based on IRCHD cost of lab service <br /> IN-HOUSE and CONTRACTED LAB Fee is for all labs performed at the time of service. <br /> All Lab fees will be char ed in addition to office visits on a slidin fee scale as above. <br /> General Health Consultation-private facilities and agencies $55.0 <br /> Smoking Cessation-group setting $25.0per client <br /> Notary Public Fee $15.0 <br /> Return Check Service Charge $15.00 or 5%of the face amount of the check,draft or order,whichever is greater not to <br /> exceed$150.00. S.215.34(2), F.S.) (DOHP 56-66-08-AR Policy) <br /> Special reports(Physician's narrative,insurance forms,or review of medical records by physician $25.0 <br /> Cop of Medical Record/ er age$0.15 per a e and an additional$.05 for double sided copies plus cost of postage if mauled. <br /> Lar a scale co ing re uets regwrin extensive clerical assistance will be sub`ect to an$10.00 administration fee in addition to the above stated fee <br /> er FL Statute 119.07. - <br /> NOTE: Florida Statutes regardin release of medical records must be met rior to release of medical records to any source. No fees are <br /> charged to physician offices/other medical a ents with the understanding that IRCHD will also be exempt from such payment. <br /> �P„>3irtna4e�.'.tl� 5e"cr ces;• .,�_ .i`: ��',. <br /> The 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 <br /> plus$10.00 fee for each item purchased on a slid in fee basis. Insulin and E ilepsy medications can be provided at no charge if residents <br /> meet financial screening eligibility criteria. <br /> �unl�I°��t�a�sttcO�! g... : � °? CY 12-13 <br /> Birth Certificates(computer) $12.00 <br /> Birth Certificates(book) $15.00 <br /> Additional Copies(computer) $10.00 <br /> Additional Copies(book) $10.00 <br /> Death Certificates $12.00 <br /> Plastic Sleeve $5.00 <br /> Research Fee(per ear) $3.00 <br /> Expedite Fee $5.00 <br /> Overnight Shipment $15.00 <br /> Birth Certificates are provided free of charge to the following only: Children&Families Case Workers who are involved in a custodycase. <br /> Case Worker must present pro, er ID,completed application re uest and co y of the signed court etition. only one certified copy will be <br /> provided per six(6)month period. <br /> Page 5 of 9 <br /> V <br />