Common Contracts
2 similar Patient Financial Agreement contracts
Patient Financial Agreement and ResponsibilitiesPatient Financial Agreement • October 25th, 2022
Piedmont Healthcare is committed to providing patients with information regarding their coverage and financial responsibilities. In consideration of services provided by Piedmont Healthcare (PHC), the Patient or undersigned representative acting on behalf of the Patient agrees to the following:
Patient Financial Agreement and ResponsibilitiesPatient Financial Agreement • December 30th, 2019
Piedmont Healthcare is committed to providing patients with information regarding their coverage and financial responsibilities. In consideration of services provided by Piedmont Healthcare (PHC), the Patient or undersigned representative acting on behalf of the Patient agrees to the following:
