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Com Pacjent o wiadcza e dzia aj c w najlepszej wierze dostarczy wszystkie wymagane informacje do tego wniosku aby umo liwi szpitalowi ustalenie czy przys uguje jemu/jej pomoc finansowa. 1. Wniosek o pomoc finansow dla mieszka c w stanu Illinois Informacje dla pacjenta Uwaga ISTNIEJE MO LIWO UZYSKANIA BEZP ATNEJ LUB ULGOWEJ OPIEKI MEDYCZNEJ. Wype nienie tego wniosku pomo e Zespo owi S u by Zdrowia powiatu Cook ustali czy mo e Pan/Pani otrzyma bezp atne lub ulgowe us ugi oraz pomoc z innych...
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Wniosek o pomoc finansow requires information about the applicant's financial status, the reason for requesting assistance, and any supporting documents.
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