Financial Assistance

PATIENT FINANCIAL SERVICES: SHEILA WHITING, COORDINATOR  937.840.6512


For assistance with financing medications, with the option of searching by diagnosis:

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To complete a Medicaid application online:

Click Here


Financial Assistance Application

Download Application

This form must be printed and completed with physical signature at Highland District Hospital

OR

Print and complete the form with physical signature and send to:

Highland District Hospital
Attn: Patient Financial Services
1275 N. High Street
Hillsboro, Ohio 45133