Peninsula Regional Medical Center aims to make available to all patients the highest quality of medical care possible within the resources available. If a patient is unable to pay due to financial resources, all efforts will be made to help the patient obtain assistance through appropriate agencies, or, if no help is available, to render care at a reduced or zero cost for emergency and medically necessary care.

Applications can be taken orally by calling 1-877-729-7762 between 8:00 a.m. and 5:00 p.m., Monday through Friday; or in person at the Financial Counselor’s office (located in the Frank B. Hanna Outpatient Center lobby) between 8:00 a.m. and 4:00 p.m., Monday through Friday.

You may also download and fill out the application below, or read more about our policies by clicking on the documents.

Financial Assistance Policy

Financial Assistance Policy (Spanish)

Patient Collection Practice

Patient Collection Practice (Spanish)

Provider Eligibility for Financial Assistance

Federal Poverty Guidelines

Federal Poverty Guidelines (Spanish)

Financial Assistance Application

Financial Assistance Application (Spanish)

Emergency Medical Treatment and Active Labor Act (EMTALA)

Emergency Medical Treatment and Active Labor Act (Spanish)