{"hospital":{"ccn":"310044","name":"CAPITAL HEALTH MEDICAL CENTER - HOPEWELL","city":"PENNINGTON","state":"NJ","zip":"08534","phone":"609-303-4000","ownership":"Voluntary non-profit - Private","website_domain":"capitalhealth.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"*   Family Income at 0 to 200% of FPG\n Full Financial Assistance; $0 is billable to the patient.","source_id":"fap-257448d5f1298519","checked_on":"2026-10-10","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.capitalhealth.org/sites/default/files/2018-04/FAP%20Form%20from%20FI%20006%20Charity%20Care%20Policy%20Jan%202016%20-%20FINAL.pdf","layer":"documented","quote":"[Click here](https://www.capitalhealth.org/sites/default/files/2018-04/FAP%20Form%20from%20FI%20006%20Charity%20Care%20Policy%20Jan%202016%20-%20FINAL.pdf)to download/print Capital Health's Financial Assistance Application Form.","source_id":"fap-257448d5f1298519","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["photo_id","proof_of_income","social_security_letter","tax_return","bank_statements","proof_of_residency"],"layer":"documented","quote":"1. Form of Identification (i.e. Driver's License, State/County ID, S.S. Card, Birth Certificate, Passport, Visa, Alien Registration Card, Employee ID card, Student ID, or Union Membership Card).\n2. Proof of New Jersey Residency for or prior to the date of service (i.e. Utility Bill, Phone Bill, Copy of Deed or Lease, any of the above forms of ID with the address and an effective date which compares to the application date, mail received with the applicants name and current address and an attestation that the patient resides in NJ since the date of service or a letter from the landlord, roommate or other NJ resident with whom the applicant is living stating the NJ address).\n3. Income Information prior to the Date of Service (i.e. paystubs, employer letter, Benefit Statement for Unemployment, Disability or Social Security, Letter from Employer on Company letterhead stating exact income for applicable time period, Income Tax returns or a signed statement of no income and a letter of support).\n4. Asset Information as of the Date of Service (i.e. Bank Statement for Checking or Savings Account, Other Bank Accounts, IRAs, 401ks, CDs or other Stocks, Bonds or Negotiable Paper).","source_id":"fap-6ccb75219f6c8abc","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Mail completed applications (with all documentation/information specified in the application instructions) to: Capital Health Patient Accounts Department, 750 Brunswick Avenue, Trenton, NJ 08638"},{"kind":"in_person","detail":"Obtained at Capital Health’s main Outpatient Registration desk."},{"kind":"mail","detail":"Request documents be mailed to you, by calling Capital Health’s Patient Accounts Department at 609-394-6023."},{"kind":"portal","detail":"Download the documents from the Capital Health website"}],"layer":"documented","quote":"**How to Apply** – FAP and the related Application Form may be obtained/completed/submitted as follows:\n1.   Obtained at Capital Health’s main Outpatient Registration desk.\n2.   Request documents be mailed to you, by calling Capital Health’s Patient Accounts Department at 609-394-6023.\n3.   Download the documents from the Capital Health website\n4.   Mail completed applications (with all documentation/information specified in the application instructions) to: Capital Health Patient Accounts Department, 750 Brunswick Avenue, Trenton, NJ 08638","source_id":"fap-257448d5f1298519","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"609-394-6023","layer":"documented","quote":"For help, assistance or questions, please call the Capital Health Patient Accounts Department at 609-394-6023.","source_id":"fap-257448d5f1298519","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["Capital Health Regional Medical Center","Capital Health Medical Center -Hopewell","Capital Health Family Health Center","Capital Health at Deborah – Emergency Services","Capital Health East Trenton"],"layer":"documented","quote":"If you would like to schedule an appointment or if you have any questions, please call 609-362-2200 for all Capital Health Locations listed below.\nCapital Health Regional Medical Center\nCapital Health Medical Center -Hopewell\nCapital Health Family Health Center\nCapital Health at Deborah – Emergency Services\nCapital Health East Trenton","source_id":"fap-6ccb75219f6c8abc","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-257448d5f1298519","kind":"hospital_web","url":"https://www.capitalhealth.org/patients-visitors/bills-and-insurance/financial-assistance","title":"Financial Assistance | Capital Health Hospitals","fetched_on":"2026-10-10","sha256":"257448d5f1298519a59132d5aca414aea476b0018b63fd579906960712852619","effective_date":null},{"id":"fap-503aef7fde225cac","kind":"hospital_web","url":"https://www.capitalhealth.org/patients-visitors/bills-and-insurance/financial-assistance/charity-care","title":"Charity Care | Capital Health Hospitals","fetched_on":"2026-10-10","sha256":"503aef7fde225cac560f9d283bf439fa43a0208faf02062b184847c2e965826f","effective_date":null},{"id":"fap-4671faf88fb26189","kind":"hospital_web","url":"https://www.capitalhealth.org/patients-visitors/bills-and-insurance/financial-assistance/fap-other-languages","title":"Financial Assistance Policy in Non-English Languages","fetched_on":"2026-10-10","sha256":"4671faf88fb2618926d7c3234a390119650025d6602acaf0a9b087a1ec5ab3a3","effective_date":null},{"id":"fap-ad53c09335f099c6","kind":"hospital_web","url":"https://www.capitalhealth.org/sites/default/files/2018-04/FAP%20Form%20from%20FI%20006%20Charity%20Care%20Policy%20Jan%202016%20-%20FINAL.pdf","title":"Click here","fetched_on":"2026-10-10","sha256":"ad53c09335f099c624c9dd794432abe1f8f6db429db0274f5f76130f272c856d","effective_date":null},{"id":"fap-6ccb75219f6c8abc","kind":"hospital_web","url":"https://www.capitalhealth.org/sites/default/files/2024-01/Charity-Care-Fact-Sheet-English-2024.pdf","title":"Charity Care Fact Sheet (English)","fetched_on":"2026-10-10","sha256":"6ccb75219f6c8abc41b72da8f600c104858e91a72da24b9af18a8637222b3ec4","effective_date":null},{"id":"fap-7b0e72fd00ab5891","kind":"hospital_web","url":"https://www.capitalhealth.org/sites/default/files/2024-01/Charity-Care-Fact-Sheet-English-ES-2024.pdf","title":"Charity Care Fact Sheet (Spanish)","fetched_on":"2026-10-10","sha256":"7b0e72fd00ab5891dc28ac51ff1173cbb06e9cf76a966b43c683602698ac2cd0","effective_date":null}],"accuracy":null}