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Hospital Statement of CostBHF Page 1Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763General InformationPRELIMINARYName of Hospital: OSF Heart of
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Visit the OSF Heart of Mary website or obtain the form from the admissions office.
02
Fill in your personal details, including name, address, and contact information.
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Provide medical history and any allergies or ongoing treatments.
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Select your preferred payment method and fill in the necessary financial information.
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Review the application carefully to ensure all information is accurate.
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Submit the completed form either online or at the designated admission office.

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Individuals seeking comprehensive healthcare services.
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Patients needing specialized medical treatment.
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Families looking for a supportive healthcare environment.
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Community members in need of wellness programs and resources.
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OSF Heart of Mary refers to an organization or program often associated with community service, religious missions, or charitable activities focused on helping those in need, reflecting the values of the Order of St. Francis.
Individuals or organizations involved in specific activities or programs under the OSF Heart of Mary, typically those seeking funding, reporting community service, or compliance with organizational requirements may be required to file.
Filling out the OSF Heart of Mary form usually involves providing necessary personal and organizational information, detailing the activities undertaken, and ensuring all documentation is accurate and complete according to the provided guidelines.
The purpose of OSF Heart of Mary is to promote community welfare, engage in charitable acts, and support individuals in need through various programs and initiatives that align with the mission of the Order of St. Francis.
Required information may include the names of participants, description of activities, financial expenditures, outcomes of programs, and any supporting documentation that demonstrates compliance with reporting guidelines.
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