Application for Financial Assistance - Children's Hospitals and ... - childrensmn 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Where have you received care?' section. Check all applicable locations to ensure accurate processing.
3. In the 'Minnesota Healthcare Programs' section, indicate if you have applied for Medical Assistance or MinnesotaCare by selecting 'Yes' or 'No'.
4. Complete the 'Applicant' section with your personal details, including name, date of birth, address, and contact information. Ensure accuracy as this information is crucial.
5. Provide income verification details in the 'Monthly Income and Assets' section. List all sources of income and attach proof as required.
6. Fill out the 'Authorization(s)' section by signing and dating where indicated. This confirms that your information is accurate and allows for necessary verifications.

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