Get Community Care Application - Hopedale Medical Complex

Filling out the COMMUNITY CARE APPLICATION is an important step in accessing support services at Hopedale Medical Complex. This guide will provide you with detailed, step-by-step instructions to help you complete the application accurately and efficiently.

Follow the steps to fill out the COMMUNITY CARE APPLICATION online.

1. Click ‘Get Form’ button to obtain the application and open it in your preferred document editor.
2. Begin by entering your patient information. This includes your last name, first name, middle initial, date of birth, and full address including street, apartment number (if applicable), city, state, and zip code.
3. Fill out the section regarding your spouse or parent information if you are a minor. Include their last name, first name, middle initial, address, relationship to you, and social security number. Also, provide contact numbers and income information.
4. Complete the income section for each employed family member. You may include documentation such as tax returns, W-2s, or pay stubs. If you cannot provide documentation, fill out the certification statement provided in this section.
5. List the names and birthdates of all household members in the designated area. This ensures that Hopedale Medical Complex can assess your application accurately.
6. If there are any specific circumstances that may aid your application, such as unemployment status or current financial difficulties, provide this information in the comments section.
7. Review all the information you have entered to ensure accuracy. Then, complete the applicant certification section by signing and dating the form.
8. After confirming that all sections are complete, save any changes made to the document. You can choose to download, print, or share the form as needed.

Take the next step in your healthcare journey by completing the COMMUNITY CARE APPLICATION online today.