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CHI Health Hospitals Financial Assistance Application Form Instructions This is an application for financial assistance at a CommonSpirit Health facility. CommonSpirit Health provides financial assistance
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Bring the completed forms with you to the hospital on the day of your appointment or admission.

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CHI Health is a regional health network with hospitals in Nebraska and southwest Iowa.
Healthcare providers and facilities who are part of the CHI Health network are required to file CHI Health hospitals.
Providers and facilities must fill out the CHI Health hospitals form with accurate and complete information.
The purpose of CHI Health hospitals is to report data on the services provided by healthcare facilities within the network.
Information such as patient admissions, procedures performed, and outcomes must be reported on CHI Health hospitals.
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