{"hospital":{"ccn":"101314","name":"DOCTORS MEMORIAL HOSPITAL INC","city":"PERRY","state":"FL","zip":"32347","phone":"850-584-0800","ownership":"Voluntary non-profit - Private","website_domain":"doctorsmemorial.com","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Approved patients whose gross household income falls at or below 200% of current Federal Poverty Level will be considered for the maximum allowable write off of 100%.","source_id":"fap-eb9d944bcd415e0c","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":null,"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":{"value":"https://www.doctorsmemorial.com/wp-content/uploads/2021/07/Financial-Assistance-Form.pdf","layer":"documented","quote":"[Declaration financial statement form](https://www.doctorsmemorial.com/wp-content/uploads/2023/10/Declaration-Financial-Statement-2022-PDF-Form.pdf)","source_id":"application-74ac4e57167dfbf3","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["proof_of_residency"],"layer":"documented","quote":"Proof of Residency: Return documents verifying address and county you live in (electric bill, water bill, etc.)","source_id":"application-b552565d9a33e454","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"The applicant will be notified within 30 calendar days of receipt of a complete application.","source_id":"billing-28ce5a6c1c2e582e","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"850-584-0862 or 850-584-0863","layer":"documented","quote":"Patient Financial Services representatives are available to assist you in understanding the financial assistance program and to answer any questions you may have. Should you need assistance in any other language besides English, the program may be able to provide a translator for you. The financial counselor will also be able to assist or inform you of other programs such as Medicaid, Disability and Vocational Rehabilitation Services that may assist you with your hospital bill. Our financial counselors will also be able to direct you to healthcare navigators within our community that can assist you with finding insurance through the market-place exchange.","source_id":"billing-28ce5a6c1c2e582e","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"hours":{"value":"Monday through Friday, 8:30 – 4 p.m.","layer":"documented","quote":"Patient Financial Services\n333 N. Byron Butler Parkway\nPerry, FL 32347\nPhone: 850-584-0862 or 850-584-0863\nHours: Monday through Friday, 8:30 – 4 p.m.","source_id":"billing-28ce5a6c1c2e582e","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"languages":{"value":["English"],"layer":"documented","quote":"Should you need assistance in any other language besides English, the program may be able to provide a translator for you.","source_id":"billing-28ce5a6c1c2e582e","checked_on":"2026-10-11","confidence":1.0,"support_count":0}},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"application-74ac4e57167dfbf3","kind":"hospital_web","url":"https://www.doctorsmemorial.com/financial-assistance-application","title":"Financial Assistance Application","fetched_on":"2026-10-11","sha256":"74ac4e57167dfbf36782c98037a42bf57a146085dde2f6486bd448c01493f140","effective_date":null},{"id":"summary-d18595afc84a4274","kind":"hospital_web","url":"https://www.doctorsmemorial.com/wp-content/uploads/2021/12/Financial-Assistance-Policy-Plain-Language-Summary.pdf","title":"[PDF] Financial Assistance Policy Plain Language Summary","fetched_on":"2026-10-11","sha256":"d18595afc84a42743efef167b6be7ecfece8f741cca36138c3ef887307a2ed10","effective_date":null},{"id":"billing-28ce5a6c1c2e582e","kind":"hospital_web","url":"https://www.doctorsmemorial.com/patients-visitors/financial-billing-information","title":"Financial & Billing Information - Doctors' Memorial Hospital","fetched_on":"2026-10-11","sha256":"28ce5a6c1c2e582e63dd9c920663a78e47e06f3958e3d990cca778e0ed293e28","effective_date":null},{"id":"billing-769391bbcbfc0073","kind":"hospital_web","url":"https://doctorsmem.wpengine.com/financial-billing-information","title":"Billing and Collections Policy","fetched_on":"2026-10-11","sha256":"769391bbcbfc007332e6f3ede6bd7939cb18be9d3fa7f0c1e053a2c3023513dc","effective_date":null},{"id":"fap-eb9d944bcd415e0c","kind":"hospital_web","url":"https://www.doctorsmemorial.com/wp-content/uploads/2021/12/066.30-Financia-Assistance-FY-2015.10.21.2015.pdf","title":"Financial Assistance Policy and Procedure","fetched_on":"2026-10-11","sha256":"eb9d944bcd415e0c21366c7a2f78c405780e93751a59751cd02436a587284e21","effective_date":null},{"id":"application-055e1b204cbaae46","kind":"hospital_web","url":"https://www.doctorsmemorial.com/financial-assistance-application/","title":"Financial Assistance Application","fetched_on":"2026-10-11","sha256":"055e1b204cbaae46d3286fe7b8388f2956d9fa5513745152ab1cd6ab50eb3c08","effective_date":null},{"id":"application-c921dcbf55f7717f","kind":"hospital_web","url":"https://www.doctorsmemorial.com/wp-content/uploads/2021/07/Financial-Assistance-Form.pdf","title":"Financial Assistance Application","fetched_on":"2026-10-11","sha256":"c921dcbf55f7717faa85fa3e9f90d15e7639ea545cc24205c4e06b4e54f2610e","effective_date":null},{"id":"application-b552565d9a33e454","kind":"hospital_web","url":"https://www.doctorsmemorial.com/wp-content/uploads/2023/10/FA-Application-Letter-2022-PDF-Form.pdf","title":"Financial Assistance appLICATION letter","fetched_on":"2026-10-11","sha256":"b552565d9a33e454070af944ced88094db85552b374dde42c6685ed335d4d8c6","effective_date":null}],"accuracy":null}