Financial Assistance Program

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Financial Screening Checklist
Financial Screening checklists (Spanish)

If you are not able to pay your bill, please read this important information on the options available to you.

English
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III - Participating Providers

Arabic
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Gujarati
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Hindi
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit IIIParticipating Providers

Korean
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Mandarin
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Polish
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Portuguese
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Russian
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Spanish
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Tagalog
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers

Vietnamese
Financial Assistance Program
Plain Language Summary
Exhibit I - Fee Schedule
Exhibit III Participating Providers