Any patient may apply to receive financial assistance. A patient seeking financial assistance must provide supporting documentation specified in the application unless RHSHC indicates otherwise. For questions, more information, or if you need the below forms in another language, please call 563-547-2101 and ask to speak with our Financial Counselor.
- Financial Assistance Application (English)
- Financial Assistance Application (Spanish)
- Medicaid Application (English)
- Medicaid Application (Spanish)