Charity care unc application: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to modify APPLICATION FOR CHARITY FREE CARE PROGRAM (PROOF OF ... online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork takes only some simple clicks. Make these quick steps to modify the PDF APPLICATION FOR CHARITY FREE CARE PROGRAM (PROOF OF ... online for free:

Sign up and log in to your account. Sign in to the editor with your credentials or click on Create free account to test the tool’s features.
Add the APPLICATION FOR CHARITY FREE CARE PROGRAM (PROOF OF ... for editing. Click the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or via a link.
Change your document. Make any adjustments required: insert text and photos to your APPLICATION FOR CHARITY FREE CARE PROGRAM (PROOF OF ..., underline details that matter, erase sections of content and replace them with new ones, and add symbols, checkmarks, and fields for filling out.
Finish redacting the form. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the parties involved.

Our editor is very intuitive and efficient. Try it out now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

How do I write a letter to medical aid?

Dear Sir, I want to request your kind support for my medical treatment (mention the medical problem or disease). During my last visit to the doctor/hospital (hospital name), they provided me with a minimum treatment estimate (mention the amount).

What does UNC charity care cover?

The Charity Care Program insures that all eligible individuals receive medically necessary care at participating UNC Health Care entities regardless of their ability to pay. The program is available for patients with a household income of at or below 250% of the Federal Poverty Guideline for their family size.

How do I write a letter to medical financial assistance?

Dear (Sir/Madam, or name if available): Enclosed is a copy of my completed application for financial assistance. Thank you for offering a financial assistance program. I am uninsured [and/or] unable to pay for my medical care.

Who are eligible for the charity program?

Charity Care means the ability to receive "free care." Patients who are uninsured for the relevant, medically necessary service, who are ineligible for governmental or other insurance coverage, and who have family incomes not in excess of 300 percent of the Federal Poverty Level will be eligible to receive "free care." ...

What is charity care New Jersey?

The New Jersey Hospital Care Payment Assistance Program (Charity Care) is available to patients for inpatient and outpatient services at all acute care hospitals throughout New Jersey. Medically necessary services may be eligible for patients who meet income and asset criteria.

Related forms

be ready to get more