Get the free Sliding Fee Discount Program Application Form v6.2024
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For Official Use Only: Submission Date: ___GUAM BEHAVIORAL HEALTH AND WELLNESS CENTER SLIDING FEE SCALE APPLICATIONVerification Date:___ Medical Record Number: #: ___SECTION A APPLICANT INFORMATION
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What is sliding fee discount program?
A sliding fee discount program is a financial assistance mechanism that adjusts the cost of healthcare services based on a patient's ability to pay, typically considering their income and family size.
Who is required to file sliding fee discount program?
Healthcare providers and organizations that participate in certain federal programs, such as Community Health Centers (CHCs), are required to file a sliding fee discount program to ensure that low-income patients can access services at reduced prices.
How to fill out sliding fee discount program?
To fill out a sliding fee discount program, a patient typically needs to provide personal and financial information, including income verification and family size, on the designated application form provided by the healthcare provider.
What is the purpose of sliding fee discount program?
The purpose of the sliding fee discount program is to enhance access to healthcare services for low-income individuals by reducing financial barriers, thus promoting health equity.
What information must be reported on sliding fee discount program?
Information that must be reported on the sliding fee discount program includes patient income, family size, and any supporting documentation that verifies financial status, as well as details about the services rendered and fees charged.
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