Get the free Sakakawea Hazen Clinic Sliding Fee Scale and application - sakmedcenter

Sacajawea Haven Clinic 517 8th Avenue NE Haven, ND 58545 TITLE: Sliding Fee Scale (SFS) Policy and Procedure PURPOSE: This program is designed for providing free or discounted care to those who have

How to fill out sakakawea hazen clinic sliding

How to fill out Sakakawea Hazen Clinic sliding:

1. Start by gathering all the necessary information and documents required for the sliding fee application. This may include proof of income, proof of residency, and any other supporting documents requested by the clinic.
2. Carefully read through the application form provided by Sakakawea Hazen Clinic. Make sure you understand all the sections and requirements before proceeding.
3. Begin filling out the application form by providing your personal information, such as your name, address, contact details, and any other requested information about yourself.
4. In the income section, accurately record your income details. This may include information about your employment, government assistance, or any other sources of income. Be prepared to provide supporting documents if necessary.
5. If you have dependents or family members who will also be covered under the sliding fee, make sure to provide their information as well. This may include their names, ages, and relationship to you.
6. Review the completed application form to ensure all the information provided is accurate and complete. Double-check for any errors or missing details before submitting.
7. Submit the filled-out application form along with any necessary supporting documents to Sakakawea Hazen Clinic. Follow their instructions on how to submit the application, whether it's through email, mail, or in-person drop-off.

Who needs Sakakawea Hazen Clinic sliding:

1. Individuals or families who are seeking healthcare services at the Sakakawea Hazen Clinic and are in need of financial assistance in covering the costs.
2. People with limited income or financial resources that may qualify them for reduced fees or discounts on medical services provided by the clinic.
3. Those who do not have health insurance coverage and are looking for affordable healthcare options.
4. Patients who are willing to provide the necessary documentation and meet the eligibility criteria set by the Sakakawea Hazen Clinic for their sliding fee program.
5. Individuals who can demonstrate residency within the service area of the Sakakawea Hazen Clinic and are in need of healthcare services.

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What is sakakawea hazen clinic sliding?

Sakakawea Hazen Clinic Sliding is a program that offers discounted medical services based on a patient's income and family size.

Who is required to file sakakawea hazen clinic sliding?

Patients who qualify for the program based on their income and family size are required to file for Sakakawea Hazen Clinic Sliding.

How to fill out sakakawea hazen clinic sliding?

To fill out Sakakawea Hazen Clinic Sliding, patients need to provide documentation of their income and family size to determine eligibility for discounted medical services.

What is the purpose of sakakawea hazen clinic sliding?

The purpose of Sakakawea Hazen Clinic Sliding is to ensure that patients who may not be able to afford full-priced medical services can still receive the care they need at a discounted rate.

What information must be reported on sakakawea hazen clinic sliding?

Patients must report their income, family size, and any other relevant financial information to determine their eligibility for the program.