Solicitud de factura detallada

Estoy solicitando una factura detallada para cada una de estas cuentas: Daniela Castillo, cuenta 5057388228, servicios del 11 de febrero de 2025 al 13 de febrero de 2025; Daniela Castillo, cuenta 5057388214, servicios del 11 de febrero de 2025 al 13 de febrero de 2025.

La ley de Florida dice que el hospital debe proporcionarla después del alta cuando se solicite, dentro de los 7 días de mi solicitud (Florida Statutes 395.301(1)(e)).

Por favor envíela a la dirección abajo. Gracias.

SAMPLE — FICTIONAL DATA. NOT A REAL LETTER.

March 2, 2026
To: Patient Financial Services, Seaside Regional Hospital

Request for an itemized statement

Dear Patient Financial Services team,

I am asking for an itemized statement for each of these accounts: Daniela Castillo, account 5057388228, services from February 11, 2025 to February 13, 2025; Daniela Castillo, account 5057388214, services from February 11, 2025 to February 13, 2025.

Florida law says the hospital must provide it after discharge upon request, within 7 days of my request (Florida Statutes 395.301(1)(e)). Florida Statutes 395.301

Please send it to the address below. Thank you.

Sincerely,
Daniela Castillo
9349 Seagrape Ln Apt 717
Bayside, FL 33067
(954) 555-0161

Signature

Where this comes from (for you, not part of the letter)

Florida Statutes 395.301, 2026, page 1: Upon request, and after the patient's discharge or release from a facility, the facility must provide to the patient or to the patient's survivor or legal guardian, as appropriate, an itemized statement or a bill detailing in plain language
Florida Statutes 395.301, 2026, page 1: The initial statement or bill shall be provided within 7 days after the patient's discharge or release or after a request for such statement or bill, whichever is later.

Rules: the public Financial Assistance Policy and form of Memorial Regional Hospital (FL; MHS = Memorial Healthcare System), applied to the fictional Seaside Regional Hospital case.