GUIDELINES
and share eligible medical bills since 1981. Our ministry model sets us apart. CHM members and staff pray with you and serve you—as Christians serving Christians. Incident occurs and you seek medical treatment Request itemized bills and discounts from your provider; submit Sharing Request Packet to CHM Eligible bills are processed and CHM sends
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2018 Form 8965 - chministries.org
www.chministries.org8965 t the Treasury Internal Revenue return Health Coverage Exemptions Attach to Form 1040. GO to www.irs.goWForm8965 for instructions and the latest information.
Acciden Veri˜ca Form - chministries.org
www.chministries.orgMOTOR VEHICLE ACCIDENT (AUTO, MOTORCYCLE, BOAT, ETC) Was the patient the: square Driversquare Passenger square Pedestrian List if the injury/accident occurred on private or public property: Name and address of the liable party: Insurance company: Claim/policy #: Address: Phone #: Adjuster’s name: Phone #:
Sharing Request Form
www.chministries.orgPatient Name: Date of birth: Member#: Instructions: Complete each column to reflect the dollar amounts associated with each itemized bill’s initial charges, reductions, and other payment details. Is this worksheet an add-on (a bill, form or letter related to an incident already been submitted) to a previous incident?
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