PROVIDENCE SANTA ROSA MEMORIAL HOSPITAL

This is a nonprofit hospital subject to IRS Section 501(r). You have the following rights:

• Financial Assistance Policy Required: This hospital must maintain a written Financial Assistance Policy (FAP) and make it widely available to patients.
• No Extraordinary Collection Actions Before FAP Screening: The hospital cannot pursue wage garnishment, liens on your home, credit reporting, or lawsuits until it has made reasonable efforts to determine whether you qualify for financial assistance.
• Charge Limitations: If you qualify for financial assistance, the hospital cannot charge you more than the amounts generally billed to insured patients for the same services.
• Billing Period Protections: The hospital must wait at least 120 days after the first post-discharge billing statement before initiating any extraordinary collection actions.