Financial Hardship Policy and Application

Your office should have a written policy regarding determinations of financial hardship and a clear guideline on what qualifies as a hardship (e.g. by using federal poverty guidelines). The Financial Hardship Policy and Application provides both the official policy, and the application which is completed by the patient. 

This form is necessary and must be included in their chart if you intend to waive all or part of their co-pay (patient portion) or deductible due to various financial situations.

File Size: 67.5 KB

File Type: .doc - Word document

File Name: Financial-Hardship-Policy-and-Application.doc