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INDIAN RIVER COUNTY HEALTH DEPARTMENT <br /> FEE SCHEDULE -- Effective Oct 1 , 2003 <br /> Contracted Laboratory Services <br /> Maximum charge of $ 12 .00* $0 . 00 $2 .04 $3 . 96 $6.00 $8.04 $9 . 96 $ 12 . 00 $ 12 .00 <br /> *Includes $5 . 00 Lab Sample Collection Fee <br /> NOTE : Tests which exceed a charge of $20 .00 will be billed individually on sliding fee scale percentage based on IRCHD <br /> cost of lab service . <br /> Pharmacy <br /> Pharmaceutical items will be billed on a per pill basis at IRCHD cost. An itemized pharmaceutical listing is updated weekly <br /> and is available <br /> by contacting the cashier. Items received from the State Pharmacy as in-kind donation at no cost to IRCHD will not be <br />charged to the patient. <br /> Medical Records Fees <br /> Copy of Medical Record/per page $ 1 .00 per page for the first 25 pages ; $ .25 each additional page thereafter. <br /> NOTE : Florida Statutes regarding release of medical records must be met prior to release of medical records to any source <br />. No fees are <br /> charged to physician offices/other medical agents with the understanding that IRCHD will also be exempt from such payment. <br /> Vital Statistics Fees <br /> Birth Certificates $ 12 . 00 <br /> Additional Copies $8 . 00 <br /> Death Certificates $ 10 . 00 <br /> Research Fee ( per year) $3.00 <br /> Expedite Fee $5 . 00 <br /> Overnite Shipment $ 10 . 00 <br /> Birth Certificates are provided free of charge to the following only: Children & Families Case Workers who are involved in <br /> a custody case . <br /> Case Worker must present proper ID , completed application request and copy of the signed court petition . Only one certified <br /> copy will be <br /> provided per six (6) month period . <br /> Environmental Health County Fees <br /> Well Permit ( Potable) $75.00 Environmental Health Plan Review $75.00 <br /> Well Permit ( Irrigation ) $50 . 00 Environmental Assessment $ 150 . 00 <br /> Well Permit (2 Sites or more) $ 100 . 00 Grease Trap Construction Permit $75 . 00 <br /> Well Abandoment $0 . 00 Grease Trap Annual Operating Permit $50 .00 <br /> Well Permit Construction Variance $ 100 . 00 Hazardous Waste (SQG ) Annual Fee $50 . 00 <br /> Public Supply Well Permit $250 . 00 "After the Fact' OSTDS New System $400 . 00 <br /> Demolition Permit $50 .00 "After the Fact' OSTDS Repair Permit $230 .00 <br /> Demolition Permit $ 100 . 00 Bacteriological Water Sample ( Drinking Water) $20 . 00 <br /> Reinspection for Demolition Permit $25 . 00 Chemical Water Sample $5 . 00 - 25.00 <br /> Environmental Health Misc. Lab $20 . 00 Indoor Air Quality Permit $50 . 00 <br /> Environmental Health State Fees <br /> Please see Attachment IV <br /> 9/9/2003CLFEE2003-04 Page 5 of 7 <br />