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c.Patient's address. <br />d. Name of medical doctor who diagnosed patient <br />and certified hospitalization essential to his <br />treatment. <br />e. Physician's diagnosis. <br />f. The calendar days of hospitalization received.' <br />g. A record of payment to-this hospital. <br />and, <br />BE IT FURTHUR RESOLVED that this Board will make all medical <br />and financial records supporting direct expenditures from the <br />"Indian River County Indigent Hospitalization Fund" available for <br />review by the State Board of Health, and this Board will submit <br />quarterly to the State Board of Health a certification identifying <br />hospitalized cases and the payments for the case of each made from <br />the "Indian River County Indigent Hospitalization Fund", together <br />with a quarterly statement of expenditures certifying that all <br />such payments were made in accordance with the provisions of <br />Chapter 401, supra, and on the basis of such requisition this <br />Board will request the State Board of Health to authorize direct <br />payments to the Indian River County Board of County Commissioners <br />from Indian River County's share of the State appropriation for <br />this program, less any charges that may have been paid to hospitals <br />outside of Indian River County by the State Board of Health for <br />necessary emergency treatment of indigent Indian River County <br />residents; and, <br />BE IT FURTHUR RESOLVED, that all payments received from the <br />State of Florida through this program shall augment the "Indian <br />River County Indigent Hospitalization Fund',' and shall be expended <br />in addition to County Funds herein appropriated in accordance with <br />County Annual Budget Statute, Chapter 129, Florida Statutes; and, <br />BE IT FURTHUR RESOLVED, that a certified copy of this <br />Resolution be submitted to the Indian River County Health <br />Department and the State Board of Health <br />