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WELL STAR CHANGE GUARANTOR REQUEST FORM (PLEASE PRINT AND COMPLETE ALL APPLICABLE SECTIONS) INSTRUCTIONS A separate request must be completed from each account/visit to a Well star Facility. Please
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How to fill out wellstar change guarantor request
How to fill out wellstar change guarantor request
01
Obtain the Change Guarantor Request form from Wellstar's website or from a Wellstar representative.
02
Fill out your personal information including your name, date of birth, and contact information.
03
Provide the current guarantor's information as well as the new guarantor's information.
04
Include a detailed reason for the change in guarantor on the form.
05
Sign and date the form before submitting it to Wellstar for processing.
Who needs wellstar change guarantor request?
01
Patients who currently have a guarantor responsible for their medical bills but wish to change the guarantor.
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What is wellstar change guarantor request?
The wellstar change guarantor request is a form used to update the guarantor information for a patient at Wellstar Health System.
Who is required to file wellstar change guarantor request?
The patient or the legal guardian of the patient is required to file the wellstar change guarantor request.
How to fill out wellstar change guarantor request?
The wellstar change guarantor request can be filled out online through the Wellstar Health System patient portal or by requesting a paper form from the hospital or healthcare provider.
What is the purpose of wellstar change guarantor request?
The purpose of the wellstar change guarantor request is to ensure that the correct person is responsible for the medical bills and other financial obligations related to the patient's care.
What information must be reported on wellstar change guarantor request?
The wellstar change guarantor request typically requires information such as the new guarantor's name, contact information, relationship to the patient, and any relevant insurance information.
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