HCAI Syfphr

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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

PETALUMA VALLEY HOSPITAL

400 NORTH MCDOWELL BOULEVARD
PETALUMA, CA 94954
http://stjosephhealth.org/

License:

General Acute Care Hospital
Total Beds: 80
Emergency Room: Yes
more... Link to Atlas

Contact:

Linda Harvey
(971)358-9401

OSHPD ID:

106491001

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

4/1/2023

Download:

Federal Poverty Level for Free Care:

300%

Discount Payment Effective Date:

2/1/2023

Discount Payments

FPL Range: 301%-400%
Payment Basis:
Medicare
Other: Sliding scale discount of Medicare payments

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

4/1/2023

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: See application for details

Language Information

Available Languages:

English
Spanish
Vietnamese
Tagalog
Korean
Chinese
Armenian
Russian
Other: see webite for more details

Additional Information

Updated charity care/bad debt policy as well as the financial assistance application

Family Size	100%	150%	200%	250%	300%	350%	400%