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RSA Sliding Fee Discount 2015 APPLICATION Last Name First Name Mailing Address Household Information Primary Phone Date of Service City State Medicare Private Hispanic/ Latino? (Yes/No) AK Native

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For pdfFiller’s FAQs

What is sliding fee - search?

Sliding fee scale is a payment structure that allows individuals to pay for services based on their income and ability to pay.

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Healthcare providers or organizations providing services on a sliding fee scale are required to file sliding fee search.

How to fill out sliding fee - search?

To fill out sliding fee search, providers need to gather income information from patients, determine the fee based on the sliding scale, and document the process.

What is the purpose of sliding fee - search?

The purpose of sliding fee search is to ensure affordability of healthcare services for individuals with varying income levels.

What information must be reported on sliding fee - search?

Information such as patient income, family size, calculated fee based on sliding scale, and any discounts applied must be reported on sliding fee search.

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