If the information is not collected during your initial contact with EMS personnel, you will receive a statement of charges from Orange County EMS along with a patient insurance form (PDF). You are encouraged to complete this form so we will have all the pertinent information needed to file your claim correctly. Please include the following information: The policy number, subscriber identification number, group number, insured name and complete mailing address of the insurance company.
Please mail, fax or email the completed form to our office promptly as this information is time sensitive. Please mail your completed form to the address found on top of the document. If you prefer, you may fax your form to 919-644-3091 or email the Tax Office an electronic copy. If insurance information is not provided within 6 months of the date of service, we may not be able to file your insurance due to timely filing limitations.