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Wythe County Community Hospital fax number
(804) 381-4508
Financial Services
Used for: Financial assistance application submission
Fax destination details
- Department
- Financial Services
- Purpose
- Financial assistance application submission
- Form
- Application for Assistance — Wythe County Community Hospital Financial Assistance Application
- Address
- Wythe County Community Hospital, 600 West Ridge Road, Wytheville, VA 24382
- Voice phone
- 855-426-0148
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Submit the completed Application for Assistance with all required documents: 1) copies of checking and/or savings accounts for the previous month; 2) real estate and personal property tax tickets from the previous year; 3) verification of all household income for the past 90 days (including Social Security, Disability, and spouse's income); 4) denial letter from the Dept of Social Services or First Source indicating non-qualification for assistance; 5) if uninsured, a letter showing that you applied for insurance through healthcare.gov and were unable to obtain assistance with premium payments; 6) copies of Wythe County Community Hospital bills you have received (if any). Before your application will be considered for assistance, all of the above must be provided (or a valid reason why it doesn’t apply) within 30 days from discharge date along with a fully completed application.
Official form instructions are published as a downloadable file on the organization's website.
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