WH websites with medical documentation

 Common Financial Assistance Forms

The Health Council’s hospital members in Ohio have agreed to accept a common application form for patients seeking financial assistance. The purpose of the form is to reduce the paperwork burden for patient’s seeking financial assistance. The new application, which is provided in English and Spanish, would not replace a hospital’s current financial assistance form, but hospitals agreed to accept the new common form if presented by the patient. The committee will review the form annually to ensure it meets Ohio Hospital Care Assurance Program (HCAP) requirements and the needs of hospitals and their patients.

Greater Cincinnati Health Council Ohio Member Hospitals Application for HCAP: