Get Sentara Discharge Papers

The Sentara Discharge Papers are essential for patients seeking financial assistance after their hospital discharge. This guide will provide clear and supportive instructions to help users navigate the form effectively.

Follow the steps to complete the Sentara Discharge Papers online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's name and account number at the top of the form. Ensure all information is accurate, as this will relate directly to the patient’s financial assistance request.
3. Next, provide the patient’s address and phone number. This information is vital for communication regarding their application.
4. Input the admission and discharge dates, which helps establish the timeline of care provided.
5. Fill in the total charges and write-off amount. This section outlines the financial details of the patient's care and the assistance requested.
6. Indicate who is requesting assistance by writing their name and relationship to the patient. This clarity is crucial for the processing of the form.
7. List every member of the patient's household, ensuring to include their ages and monthly income sources. You may use additional sheets if necessary to include all members.
8. In the assets, liabilities, income, and expenses section, specify whether the patient owns or rents their home and include the monthly payment amounts. This helps in assessing financial needs.
9. Detail the patient’s vehicle ownership status and related costs, which provides insight into ongoing financial commitments.
10. Select the appropriate category for monthly living expenses, as this information aids in evaluating overall financial support.
11. Document the total family income for the last three months and provide balances for checking and savings accounts, along with retirement savings.
12. Indicate any additional resources received, such as insurance or governmental aid, which may affect eligibility for assistance.
13. If applicable, provide information regarding any accidents related to the service for which the patient may have a claim.
14. Finish by certifying the accuracy of the provided information with a signature and date. This confirms the commitment to the truthfulness of the application.
15. Finally, users can save changes, download, print, or share the form as needed for submission.

Complete the Sentara Discharge Papers online today to access the financial assistance you may be eligible for.