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PATIENT IDENTIFICATION Charity Care/Financial Assistance Application Form confidentialPlease fill out all information completely. If it does not apply, write NA. Attach additional pages if needed.
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What is yes no if yes?
It is a decision point where the answer can either be yes or no.
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Anyone who falls under the category specified.
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Simply mark either yes or no based on the situation.
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To determine a course of action based on the response.
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Any relevant information related to the decision point.
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