Wakemed charity care 2026

1. Click ‘Get Form’ to open the wakemed charity care application in the editor.
2. Begin by filling out the Guarantor/Patient Information section. Provide your name, Social Security number, date of birth, and account number. Indicate if the patient is deceased and attach a death certificate if applicable.
3. Complete your address details including city, state, and zip code. Include both home and cell phone numbers, and confirm your citizenship status.
4. In the Spouse (Parent) Information section, enter relevant details about your spouse or parent if applicable.
5. List all household members who have received care at WakeMed. If more space is needed, add additional members on a separate sheet.
6. Fill out the Health Insurance/Other Assistance section by indicating any assistance programs you have applied for and checking applicable insurance options.
7. Provide Employment Status information for yourself and your spouse, detailing current and prior employers along with salary information.
8. Complete sections regarding income sources, assets, liabilities, banking information, life insurance policies, and certification at the end of the form.

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