Get Act 306 Hb 435 Regulatory Advisory

Filling out the Act 306 Hb 435 Regulatory Advisory is essential for understanding your healthcare provider's disclosures and your rights as a patient. This guide will walk you through the process of completing the form online with clear instructions tailored to your needs.

Follow the steps to complete the form accurately

1. Click ‘Get Form’ button to access the Act 306 Hb 435 Regulatory Advisory and open it in your document editor.
2. Begin by filling in the name of the patient's health insurance plan in the designated space. This information is critical for verifying the participation status of the hospital with your insurance.
3. Next, provide the specific dates of service when you received care at Park Place Surgical Hospital in the appropriate section.
4. Initial the acknowledgment sections by placing your initials where indicated. This shows you understand the disclosures regarding balance billing and independent healthcare professionals.
5. Read through the balance billing disclosure notice thoroughly. Ensure you understand the implications regarding independent healthcare professionals and their potential separate charges.
6. If applicable, fill in the name and contact information of healthcare professionals you have consulted as required by the disclosure. Make sure all details are correct.
7. Finally, after confirming all the information is accurate, provide your signature and the current date in the designated fields, indicating your understanding and consent to the disclosures.
8. You can then save the changes, download, print, or share the completed form as needed.

Complete your Act 306 Hb 435 Regulatory Advisory online today for clarity on your healthcare charges.