Peace health financial assistance application 2026

1. Click ‘Get Form’ to open the peace health financial assistance application in the editor.
2. Begin with SECTION A by entering the Guarantor's name, home address, and contact numbers. Ensure accuracy as this information is crucial for processing your application.
3. In SECTION B, list all household members along with their relationship to the Guarantor, date of birth, citizenship status, and employment status. Use the provided fields to ensure all necessary details are captured.
4. Proceed to SECTION C to document monthly income. Attach copies of tax returns and pay stubs as required. Fill in gross wages for each wage earner and any other sources of income.
5. SECTION D requires you to list assets. Provide descriptions and market values for each asset, ensuring you include supporting documentation.
6. In SECTION E, detail any outstanding debts or medical bills. This helps PeaceHealth assess your financial situation comprehensively.
7. Complete SECTION F by answering supplemental questions regarding insurance and financial status. This section is vital for determining eligibility.
8. Finally, review your entries for accuracy before signing at the end of the form in SECTION G. Your signature certifies that all information is correct.

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