Dear Patient:

Community Hospital Fairfax (CH-F) is aware that sometimes medical services need to be provided at times when a patient’s ability to pay is restricted.  It is the policy of CH-F to make every effort to assist its uninsured or underinsured patients to find a source of funding.  We encourage you to apply for Medicaid benefits if you believe you might qualify.

CH-F has a charity/medically indigent program that can assist financially–restricted patients needing medical services at CH-F.  The following guidelines can help you determine if you think you might qualify for our charity discounting:

  1.  You must complete and sign the application and attach all the required documentation.  If  there is little or no income please enclose an explanation of  how bills (i.e., utilities, rent, groceries) are being paid.
  2. For self-employed patients your last filed income tax return and asset/liability statement will also be used to consider qualifying for the discount.
  3. Charity application and required documentation must be received within 2 weeks of receipt to be considered.
  4. ALL documentation must be attached or the charity application will NOT be considered.

Thank you for choosing Community Hospital Fairfax as your healthcare provider of choice.  For assistance with the charity discounting, please contact me at (660)686-2326.

New Charity App 01152010.pdf

New Charity App 01152010 cont .pdf

FIN0005-Financial Assistance Policy (revised).pdf

FAP PLS.pdf