STATE OF FLORIDA F i a) AGENCY FOR HEALTH CARE ADMINISTRATION” °°” CITY OF ORLANDO, Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. 188 UN 1 A: OE IN te A Sb HIVESION OF ADMINISTRATIVE DOAH CASE NG ORIG! AHCA NO. 2007008733 DETERMINATION NO. 20070605-012 FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (‘Petition’) that the Petitioner filed on August 1, 2007. On August 9, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law J udge (“ALJ”). On December 11, 2007, the Petitioner filed a Notice of Voluntary Dismissal, stating that the parties had resolved the dispute. On December 12, 2007, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioner’s Petition is dismissed with prejudice and the Agency’s July 10, 2007, Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s July 10, 2007, Determination to Halifax Medical Center within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Ms. Twan Jackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this £2 day of Seno , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary “t= AGENCY FOR\HEALTH CARE ADMINISTRAYION NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE PRESCRIBED BY LAW WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this £3 day of Jane, 2008. ‘RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: . William F. Quattlebaum ' Mari H. McCully, Esquire . “| Administrative Law Judge Department of Financial Services Division of Administrative Hearings Division of Worker’s Compensation The DeSoto Building 200 East Gaines Street 1230 Apalachee Parkway Tallahassee, Florida 32399-4229 Tallahassee, Florida 32399-3060 Timothy L. Newhall, Esquire Jan Mills Law Offices of Timothy L. Newhall, L.L.C. Facilities Intake 1334 Timberlane Road, Suite 11 Tallahassee, Florida 32312 Audrey A. Pike, Esquire Elizabeth Dudek Halifax Medical Center Health Quality Assurance 303 North Clyde Morris Boulevard Daytona Beach, Florida 32114 Annamarie Craft, Esquire Patient Business & Financial Services Stiles, Taylor & Grace, P.A. Post Office Box 2830 Post Office Box 1140 Daytona Beach, Florida 32120-2830 Tallahassee, Florida 32302

Docket for Case No: 07-003614