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Sentara financial assistance 2026
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- Click ‘Get Form’ to open the Sentara Financial Assistance application in the editor.
- Begin by entering the Patient Name and Account Number at the top of the form. Ensure that all details are accurate for proper processing.
- Fill in the Patient Address, Phone Number, Admit Date, and Discharge Date. This information is crucial for identifying your case.
- In the Charges section, input Total Charges and Write Off Amount. This helps assess your financial needs.
- List every member of the patient’s household along with their age and relationship to the patient. Use additional sheets if necessary.
- Complete the Assets, Liabilities, Income, and Expenses section by indicating whether you own or rent your home and providing relevant financial details.
- Review all sections for accuracy before signing and dating the application at the bottom. Your signature authorizes Sentara Hospitals to verify your information.
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