General Acute Care Hospital
Total Beds: 99
Emergency Room: Yes
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Lisa Sousamain
(909) 596-7733 Ext. 2166
Fair Pricing Policy Information
1/1/2016
200%
1/1/2016
Discount Payment 1
FPL Range:
201%-250%
Payment Basis:
Other: Patient is responsible for 25% of total bill.
Discount Payment 2
FPL Range:
251%-300%
Payment Basis:
Other: Patient is responsible for 50% of total bill.
Discount Payment 3
FPL Range:
301%-350%
Payment Basis:
Other: Patient is responsible for 75% of total bill.
Application Form Information
1/1/2016
Salary Received
Interest Received
Pension Received
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