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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

SONOMA SPECIALTY HOSPITAL

501 PETALUMA AVENUE
SEBASTOPOL, CA 95472
http://www.palmdrivehospital.com

License:

General Acute Care Hospital
Total Beds: 37
Emergency Room: Yes
more... Link to Atlas

Contact:

Palm Drive Business Office
(707) 823-8511

OSHPD ID:

106491338

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

9/1/2005

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

9/1/2005

Discount Payments

FPL Range: 201%-350%
Payment Basis:
Medicare

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

7/1/2011

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received

Language Information

Available Languages:

English
Spanish

Additional Information

Updated application to 2012 poverty guidelines

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