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County of Santa Clara Health System fax number

(408) 494-7848

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Patient Access Department

Used for: Submission and processing of the Financial Assistance Application for hospital services; FAA and supporting documents are faxed or emailed for evaluation.

Fax destination details

Department
Patient Access Department
Purpose
Submission and processing of the Financial Assistance Application for hospital services; FAA and supporting documents are faxed or emailed for evaluation.
Form
Financial Assistance Application — FINANCIAL ASSISTANCE APPLICATION FOR PATIENTS
Address
770 S Bascom Ave, San Jose, CA 95128
Voice phone
1-408-494-7850

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Complete the Financial Assistance Application for Patients and return it with required verifying documents by mail, fax (1-408-494-7848), or secure email to FinancialAssistance@hhs.sccgov.org; include proof of income, identity, and residency; see the notice for deadlines.

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