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Charity Care / Financial Assistance Application Form
This is an application for financial assistance (also known as charity care) at CHI Franciscan.
Washington State requires all hospitals to provide
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How to fill out charity care financial assistance
How to fill out charity care financial assistance
01
Gather all necessary financial documents, such as income statements, bank statements, and tax returns.
02
Contact the charity care department of the healthcare facility where you received or will receive treatment.
03
Request an application form for charity care financial assistance.
04
Fill out the application form completely and accurately, providing all requested information.
05
Attach copies of the required financial documents to the application form.
06
Submit the completed application form and supporting documents to the charity care department.
07
Await the review of your application by the charity care department.
08
Follow up with the department if you have not received a response within a reasonable time.
09
If approved, carefully review any terms or conditions associated with the charity care financial assistance.
10
If denied, explore other options such as Medicaid or contacting local charitable organizations for assistance.
Who needs charity care financial assistance?
01
Charity care financial assistance is typically needed by individuals who are uninsured or underinsured.
02
It is also beneficial for individuals who do not have sufficient financial resources to cover the cost of healthcare services.
03
People with low income or limited financial means may qualify for charity care financial assistance.
04
Individuals who are facing high medical bills, especially for life-threatening conditions, may also be in need of such assistance.
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What is charity care financial assistance?
Charity care financial assistance is a program that provides financial support to individuals who are unable to afford healthcare services.
Who is required to file charity care financial assistance?
Individuals who are seeking financial support for healthcare services are required to file charity care financial assistance.
How to fill out charity care financial assistance?
To fill out charity care financial assistance, individuals need to provide information about their income, expenses, and medical needs.
What is the purpose of charity care financial assistance?
The purpose of charity care financial assistance is to ensure that everyone has access to necessary healthcare services regardless of their financial situation.
What information must be reported on charity care financial assistance?
Information such as income, expenses, medical needs, and any other relevant financial information must be reported on charity care financial assistance.
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