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Indian River Memorial Hospital, Inc. d/b/an Indian River Medical Center May 06, 2015, at 12:00 PM 01:00 PMI RMC Boardroom 1000 36th Street Vero Beach, FL This meeting may be recordedMeeting Book Board
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01
Obtain the indigent care agreement form from the healthcare facility.
02
Read the agreement carefully to understand the terms and conditions.
03
Fill in your personal information, such as name, address, and contact details.
04
Provide your financial information, including income, assets, and liabilities.
05
Attach any required supporting documents, such as proof of income or residency.
06
Review the completed form to ensure all information is accurate and complete.
07
Sign and date the agreement.
08
Submit the filled out indigent care agreement form to the designated department or person at the healthcare facility.
09
Keep a copy of the agreement for your records.
10
Follow up with the healthcare facility to confirm the acceptance of your indigent care agreement.

Who needs indigent care agreement?

01
Individuals who are unable to afford the cost of healthcare services and qualify for indigent care
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An indigent care agreement is a contract between a healthcare provider and a government entity or organization that ensures low-income individuals receive necessary medical care at a reduced cost or for free.
Healthcare providers who offer services to indigent individuals or low-income patients are required to file an indigent care agreement.
To fill out an indigent care agreement, healthcare providers must include information about the services offered, eligibility criteria for indigent care, and the terms of the agreement.
The purpose of an indigent care agreement is to ensure that low-income individuals have access to essential medical services at a reduced cost or for free.
Information reported on an indigent care agreement typically includes the name of the healthcare provider, types of services offered, eligibility criteria for indigent care, and the terms of the agreement.
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