Patients & Visitors : Billing & Payment : Financial Counseling : Financial Assistance Packet

  Vea esta página en español

Listed below is all of the information you will need to apply for financial assistance.  We recommend that you begin with the Application Packet Description, which provides a brief explanation of all the forms and provides examples of how you should use the forms.

• Access the Application Packet Description

The primary application form is the HPA/UMA/CMH Financial Assistance Application.  You must complete this form and then complete the other forms as required, based on your financial situation.

• Access the HPA/UMA/CMH Financial Assistance Application

You will be required to send supporting documents in addition to the forms listed below.  The Approved Documents List gives examples of those supporting documents.

• Access the Approved Documents List

When you are ready to submit the Financial Assistance Packet, print a copy of the required forms below and complete them.  Send the required forms, the HPA/UMA/CMH Financial Assistance Application, and copies of your supporting documents to:

MUSC/UMA/CMH
One Poston Road, Suite 350
Charleston, SC  29407

• Income Declaration Statement
• Support Provider Assistance Statement
• Alimony/Child Support Statement
• Employee Verification Statement
• Employment Status Statement
• Dependent Statement

 Viewing of the documents on this page requires the free Adobe Acrobat Reader®.