Bjc financial assistance 2025

1. Click ‘Get Form’ to open the bjc financial assistance application in the editor.
2. Begin by filling out the 'Patient Information' section. Enter your name, date of birth, and optional details such as race and ethnicity. If applicable, indicate if you are a resident of Illinois.
3. Next, provide information about the person responsible for the bill, including their name, address, and contact details.
4. In the 'Employment Information' section, list your employer and that of your spouse or partner. Include addresses and phone numbers.
5. Answer the questions in the 'Other Information' section regarding any accidents or crimes related to your medical services.
6. Detail all insurance coverages in the designated section. Include types of insurance and policy numbers.
7. Complete the 'Monthly Income and Expenses' section by providing proof of income through attached documents like tax returns or pay stubs.
8. Finally, review all information for accuracy, sign the certification statement at the end of the form, and submit it via email or fax as instructed.

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