General Acute Care Hospital
Total Beds: 167
Emergency Room: Yes
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Kristine Grajo, Director, PFS Self Pay
(650) 724-5286
Fair Pricing Policy Information
8/1/2016
400%
8/1/2016
Discount Payment 1
FPL Range:
400%-400%
Payment Basis:
Medicare
Medi-Cal
Other Government Insurance
Discount Payment 2
FPL Range:
0%-0%
Payment Basis:
Discount Payment 3
FPL Range:
0%-0%
Payment Basis:
Scenarios in which FPL is not a criteria for determining the patient's charity care discount is for Special Circumstance Financial Assistance cases: Financial assistance that provides a discount to eligible patients with annualized family income in excess of 400% of the Federal Poverty Guidelines and financial obligations resulting from medical
services provided by any SHC entity or provider that exceed 10% of annualized family income. Details are included within the policy.
Application Form Information
4/20/2020
Salary Received
Interest Received
Pension Received
Other: Income Tax Returns
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