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LABEL OR ___ LAST NAME FIRST NAME ___ DATE OF BIRTHING OF RIGHTSBehavioral Health Services Amnesia Healthcare BHO220 (3.07.20) Page 1 of 2 ORDER FROM PRINTINGAgnesian Healthcare is required by law
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FDL County Care Clinicfond is a fund set up in Fond du Lac County to provide financial assistance for medical care.
Individuals who are seeking financial assistance for medical care in Fond du Lac County are required to file FDL County Care Clinicfond.
To fill out FDL County Care Clinicfond, individuals need to provide information about their medical condition, income, and expenses.
The purpose of FDL County Care Clinicfond is to help individuals who are unable to afford medical care on their own.
Information such as medical bills, income, and expenses must be reported on FDL County Care Clinicfond.
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