Income will be annualized based upon documentation provided by you and will take into consideration seasonal employment and temporary increases and/or decreases of income and net assets.
This application (financial statements and accompanying proof of income) must be returned to the Helena SurgiCenter within fourteen working days. If additional time is required due to your medical condition, or if assistance with the financial statement is needed, contact the Business Office Coordinator at the Helena SurgiCenter. Please send the completed information form to us in the enclosed self-addressed envelope.
The SurgiCenter will notify you in writing of the final determination of eligibility within fourteen working days of receipt of the financial statement and proof of income documentation.
All information relating to the application for Patient Assistance will be kept
confidential.