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Get Rapides Regional Medical Center Financial Assistance Applications Form

Any other medical bills you may have; such as physician, radiology, ambulance, etc. In order to be considered for a full or partial assistance, you must complete the Financial Assistance Application. The responsible party must sign the bottom, and return the completed application within fourteen (14) days of receipt. Inpatient Visits: If you were admitted into the hospital as an inpatient, it is necessary for you to provide us with your latest Federal Tax Return for supporting documentation. If.

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