Financial Assistance UF Health North provides emergency (as defined by the Emergency Medical Treatment and Labor Act, or EMTALA), urgent and other medically necessary health care services to individuals without discrimination and regardless of their ability to pay. Patients who are unable to pay for their health care services may qualify for financial assistance based upon their income. Patients who have a family adjusted income less than 200% of current federal poverty guidelines may be eligible for a discount up to 100%. Financial Assistance Policy — [En Español] Plain Language Summary (Appendix C) — [En Español] Notarized Food, Shelter and/or Monetary Verification Form Verification of Income and Medical Insurance Coverage Financial Assistance Application (Appendix B) — [En Español] Financial Assistance Income Guidelines (Appendix D) — [En Español] Billing and Collection Policy — [En Español] Uninsured patients who are not eligible for financial assistance under this policy may be eligible for a self-pay discount of 45% off gross charges. Any self-pay or financial assistance discount applied will be reversed if insurance, third-party liability, a settlement or other miscellaneous source is identified. How to Apply Financial counselors are available to provide assistance via the following: Call 904-244-4015 Email email@example.com Visit, in person, one of the following locations: UF Health Jacksonville Admissions Department 655 West 8th Street Jacksonville, Florida 32209 UF Health North Admissions Department 15255 Max Leggett Parkway Jacksonville, Florida 32218 UF Health Jacksonville Financial Eligibility Department 2000 Boulevard Jacksonville, Florida 32209 Completed applications and copies of supporting documentation may be returned to 2000 Boulevard, Jacksonville, Florida 32209 in person, or by mail to: ATTENTION: Financial Evaluation Department UF Health Jacksonville 655 West 8th Street Jacksonville, FL 32209 Patients eligible for financial assistance will not be charged more for health care services than the Amounts Generally Billed (AGB) to patients having Medicare insurance. Financial assistance applications and information are available in English and Spanish. Services provided at a UF Health Jacksonville facility by providers not employed by UF Health Jacksonville are billed independently and are not covered under this policy. View a listing of UF Health providers Los servicios prestados en el centro de salud de UF Health Jacksonville por proveedores que no son empleados de UF Health Jacksonville son facturados independientemente y no están cubiertos bajo esta póliza. Un listado de los proveedores se puede encontrar en haciendo clic aquí. Shands Jacksonville Medical Center, Inc. d/b/a UF Health Jacksonville, as a licensed health care facility in the State of Florida, gives notice, pursuant to Chapter 395.301 Florida Statutes, that it is required, prior to provision of non-emergency medical services, to give its patients written, good-faith estimates of the reasonably anticipated charges for their treatment. The estimates must be provided within seven business days after receipt of written requests by the patients or their legal guardians. Patients are also entitled to notification of revisions to the estimates.