Patient Tools
Patient Guide
Click here to read our Patient Guide and learn about the services we provide, phone numbers to have handy during your hospital stay, and much more.
Financial Assitance / Charity Care
Financial Assistance Policy – Plain Language Summary
Below find documents to apply for Salem Medical Center’s Charity Care program
English
- Affidavit of Separation
- Affidavit on behalf of patient
- Application for Participation
- Charity Care Required Document Checklist
- Patient / Responsible Party Certifications
- Spouse / Other Responsible Party Certifications
- Affidavit of Personal Recognition
- Affidavit of Unreported Income
Spanish
- Charity Care Application (Spanish)
- Declaracion de ingresos no reportados
- Declaracion de no contacto
- Declaracion de reconocimiento personal
- Declaracion de separacion
- Declaraciones en nombre del paciente
- Charity Care Required Document Checklist (Spanish)
Pricing Estimator
Click below to receive estimated prices of SMC procedures.