Home
Employee Portal
Pay my bill
Job Opportunities
Education
Public Relations
STARS Program
Public Access AED's
About Us
District History
Board Of Directors
Chief of EMS
Assistant Chief
Staff
Stations / Equipment
EMRA's
Employee Association
Submit Patient / Insurance Information
*
Indicates required field
Patient Account Number / Call Number
*
Patient's Name
*
Patient's Address
*
Patient's Phone Number
*
Patient's Date Of Birth
*
Patient's Social Security Number
*
Insurance Verification
Primary Insurance
Insurance Company Name
*
Insured's Name
*
Relationship To Patient
*
Insured's Policy ID Number
*
Group Number
*
Insured's Date Of Birth
*
Insurance Company Phone
*
Insured's Employer
*
Insured's Work Number
*
Effective Date Of Policy
*
Claims' Address (On back of card)
*
Line 1
Line 2
City
State
Zip Code
Country
Claims' Phone Number
*
Upload Copy Of Insurance Card
*
Max file size: 20MB
Secondary Insurance
Insurance Company Name
*
Insureds' Name
*
Relationship To Patient
*
Insureds's Policy ID Number
*
Group Number
*
Insureds' Date Of Birth
*
Insurance Company Phone
*
Insureds' Employer
*
Insureds' Work Number
*
Effective Date Of Policy
*
Claim's Address (On back of card)
*
Line 1
Line 2
City
State
Zip Code
Country
Claim's Phone Number
*
Upload Copy Of Insurance Card
*
Max file size: 20MB
Submit
Home
Employee Portal
Pay my bill
Job Opportunities
Education
Public Relations
STARS Program
Public Access AED's
About Us
District History
Board Of Directors
Chief of EMS
Assistant Chief
Staff
Stations / Equipment
EMRA's
Employee Association