A, PA 69 717-733-031 www.ephratahospital.org 1 9450001 03/11 Liquid Asset value could be used by Ephrata Community Hospital as a out of pocket assessment in order for you to qualify for this discount program you may be responsible for a percentage of your total balance before the discount program will cover your remaining balances. Ephrata Community Hospital If you have any questions about completing the application, please contact our Customer Service Department at (717) 738-6261.
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How to fill out the Ech Cares Application online
Completing the Ech Cares Application online is a straightforward process designed to assist users seeking financial support for healthcare services. This guide provides detailed instructions to help you navigate each section of the application with confidence.
Follow the steps to complete your application successfully.
- Click the ‘Get Form’ button to obtain the application and launch it in your online editor.
- Begin by entering your personal details in the designated fields, such as your name, date of birth, and contact information. Ensure all entries are accurate to avoid processing delays.
- Next, indicate your household size by selecting the appropriate number of family members. This is important for determining eligibility for the program based on the federal poverty guidelines.
- Provide information about your income sources. This includes listing all wages, pensions, social security, and any additional support that contributes to your financial situation. Be ready to attach supporting documentation like pay stubs and award letters.
- You will also need to declare your liquid assets. List bank accounts, certificates of deposit, and other negotiable assets. Do not include items considered non-liquid, such as real estate or retirement accounts.
- Review your entries thoroughly to ensure all necessary fields are filled out correctly. Take care to attach any required supporting documents as indicated.
- After completing the application, save any changes made. You have the option to download, print, or share the form as needed.
Complete your Ech Cares Application online today to receive the assistance you need.
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