[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-277670-105":53,"doc-detail-277670-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","wncchs-sliding-fee-discount-program-application-update","WNCCHS Sliding Fee Discount Program - Application Update","","WNCCHS Sliding Fee Discount Program application gathers patient and household details to determine financial assistance eligibility based on household size and income. Participation is optional and may reduce costs for healthcare visits and pharmacy medications, including potential lower copayments and deductibles for insured patients. Applicants select yes or no, provide personal and household information, income and other income sources, and attach income proof within 10 business days. The completed form must be signed and renewed annually.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/wncchs-sliding-fee-discount-program-application-update/277670/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/wncchs-sliding-fee-discount-program-application-update/277670.png","ImageObject",442,249,{"name":88,"@type":89},"Valentina","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"How does WNCCHS determine eligibility for the Sliding Fee Discount Program?","Question",{"text":108,"@type":109},"Eligibility is based on household size and income. The application collects household members supported by household resources and financial details to calculate assistance.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Does having insurance prevent using the Sliding Fee Discount Program?",{"text":113,"@type":109},"No. Patients with insurance can still use the program to potentially lower copayment costs and deductibles.",{"name":115,"@type":106,"acceptedAnswer":116},"What is the deadline to submit proof of income and complete the application?",{"text":117,"@type":109},"Proof of income must be provided within 10 business days of the completed application date. Applications must be filled out, documented, signed, and dated within 10 days of applying to be considered.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},277670,1790034637,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},13056703020460,"https://ap-avatar.wpscdn.com/avatar/be000253dac470eee5d?_k=1778207105932848923","Our WNCCHS Sliding Fee Discount Program is a financial assistance program for patients of our health center. Eligibility is determined based on household size and income. Participation in the Sliding Fee Discount Program is optional, but using the program can decrease your cost of all healthcare visits and pharmacy medications. Patients with insurance coverage can still utilize the program to potentially lower copayment costs and deductibles. If you do not wish to participate, you are expected to pay full prices for all services. All information collected with this application are considered strictly confidential. Sliding Fee Discount Program applies to charges/fees from all WNCCHS service lines, including medical, dental, and behavioral health services.  \nParticipation (Select One)  \n􀁻 Yes, I would like to apply for the WNCCHS Sliding Fee Discount Program.  \n􀁻 No, I do not want to apply for the WNCCHS Sliding Fee Discount Program.  \nApplicant Information  \nApplicant Name: DOB:  \nFirst Last M.I.  \nEmail: Phone:  \nMarital Status: 􀁻 Single 􀁻 Married 􀁻 Widowed 􀁻 Divorced 􀁻 Separated MyChart: YES / NO  \n\n| Interpreter? |  | YES | / | NO |  | Preferred Language: |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Refugee Status? |  | YES | / | NO |  | If YES, Country of origin: |  |  |\n| Veteran Status? |  | YES | / | NO |  |  |  |  |\n| Migrant Worker? |  | YES | / | NO |  |  |  |  |\n| Public Housing? |  | YES | / | NO |  |  |  |  |\n\n\n| Home less Status |  | Not Homeless |\n| --- | --- | --- |\n|  |  | Homeless Shelter |\n|  |  | Transitional |\n|  |  | Doubling Up |\n|  |  | Street |\n\nHousehold Information  \nList ALL individuals living within the household and supported by the financial resources of the household, including the applicant.  \n\n| Name | Date of Birth | Relationship | WNCCHS Patient? | Employed? |\n| --- | --- | --- | --- | --- |\n|  |  | SELF | YES / NO | YES / NO |\n|  |  |  | YES / NO | YES / NO |\n|  |  |  | YES / NO | YES / NO |\n|  |  |  | YES / NO | YES / NO |\n\nTotal Household Size:  \nIncome Information  \nPlease complete for all household members who are employed or self-employed. Proof of income must be provided to WNCCHS within 10 business days of completed application date to be considered for the discount program.  \n\n|  |  | How often is the employed person paid? (check one) |  |  |  | Office Use Only |\n| --- | --- | --- | --- | --- | --- | --- |\n| Employed Person | Income (before taxes) | Weekly | Bi-Weekly | Monthly | Annually | TOTALS |\n|  | $ |  |  |  |  |  |\n|  | $ |  |  |  |  |  |\n|  | $ |  |  |  |  |  |\n|  | $ |  |  |  |  |  |\n\nOther Household Sources of Income  \n\n|  |  | How often is the employed person paid? (check one) |  |  |  | Office Use Only |\n| --- | --- | --- | --- | --- | --- | --- |\n| Other Sources | Income (before taxes) | Weekly | Bi-Weekly | Monthly | Annually | TOTALS |\n| Alimony | $ |  |  |  |  |  |\n| Child Support | $ |  |  |  |  |  |\n| Social Security/Disability | $ |  |  |  |  |  |\n| Pension/Retirement | $ |  |  |  |  |  |\n| Unemployment | $ |  |  |  |  |  |\n| Other: | $ |  |  |  |  |  |\n|  |  |  | Total Annual Adjusted Gross Income: |  |  |  |\n\nDisclaimer and Signature  \nThe information on this form will be used to determine eligibility for the WNCCHS Sliding Fee Discount Program and a Federal Assistance Program. Providing false or misleading information is a violation of Federal Law. My signature certifies all the information provided is accurate and true. My signature also certifies that I received education about the WNCCHS Sliding Fee Discount Program (Brochure) and all my questions were answered prior to signing.  \nApplicant Name:  \nPrint Date  \nApplicant Name:  \nSign Date  \nProgram Requirements  \nTo receive discounts through the WNCCHS Sliding Fee Discount Program, applications must be filled out, documentation attached, signed, and dated within 10 days of applying for the program. If you are approved, WNCCHS will discount services beginning on the effective date of your","cbCaiiDQNigBgFlo","https://ap.wps.com/l/cbCaiiDQNigBgFlo","pdf",302822,"English","# Participation (Select One)\n## Applicant Information\n## Interpreter and Preferred Language\n## Household Information\n## Income Information\n## Other Household Sources of Income\n## Disclaimer and Signature\n## Program Requirements","[{\"question\":\"How does WNCCHS determine eligibility for the Sliding Fee Discount Program?\",\"answer\":\"Eligibility is based on household size and income. The application collects household members supported by household resources and financial details to calculate assistance.\"},{\"question\":\"Does having insurance prevent using the Sliding Fee Discount Program?\",\"answer\":\"No. Patients with insurance can still use the program to potentially lower copayment costs and deductibles.\"},{\"question\":\"What is the deadline to submit proof of income and complete the application?\",\"answer\":\"Proof of income must be provided within 10 business days of the completed application date. Applications must be filled out, documented, signed, and dated within 10 days of applying to be considered.\"}]","WNCCHS Sliding Fee Discount Program - Application Update | PDF",1789502927]