{"hospital":{"ccn":"310092","name":"CAPITAL HEALTH REGIONAL MEDICAL CENTER","city":"TRENTON","state":"NJ","zip":"08638","phone":"609-394-6000","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":"Income Eligibility Criteria - Patients with family gross income less than or equal to 200% of the Federal Poverty Guidelines (\"FPG\") are eligible for 100% Charity Care coverage.","source_id":"fap-61204827c1af2367","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":false,"layer":"documented","quote":"An uninsured patient is defined as a patient that has no insurance coverage for their medically necessary services and is not eligible for any State, Federal and local programs.","source_id":"fap-61204827c1af2367","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"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","pay_stubs","bank_statements","proof_of_residency"],"layer":"documented","quote":"1. Proper patient and family identification documents: This can include any of the following: driver's license, social security card, alien registry card, birth certificate, passport, visa, state issued identification, etc. 2. Proof of New Jersey Residence as of the date of service: This can include any of the following: driver's license, welfare plan identification card, utility bill, Federal income tax return, state income tax return, or an unemployment benefits statement (note: emergency care is an exception to the residency requirement). 3. Proof of gross income: This can include pay stubs, W-2's, unemployment benefit statements, etc. 4. Proof of assets as of the date of service: These are items which are readily convertible into cash. They include bank statements, investment statements, etc.","source_id":"fap-61204827c1af2367","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":"portal","detail":"Download the documents from the Capital Health website"},{"kind":"mail","detail":"Request documents be mailed to you, by calling Capital Health's Patient Accounts Department at 609-394-6023."}],"layer":"documented","quote":"**How to Apply** – FAP and the related Application Form may be obtained/completed/submitted as follows:\n\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 Medical Center – Hopewell","Capital Health Regional Medical Center"],"layer":"documented","quote":"Capital Health serves the emergency and other medically necessary healthcare needs of everyone, regardless of ability to pay in accordance with its policy on Emergency Care (Policy No. CCP-PC-002) and the Emergency Medical Treatment and Labor Act (EMTALA).","source_id":"fap-61204827c1af2367","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-61204827c1af2367","kind":"hospital_web","url":"https://www.capitalhealth.org/sites/default/files/2022-01/fi_006_charity_care_1-2022_final_english.pdf","title":"CAPITAL HEALTH SYSTEM","fetched_on":"2026-10-10","sha256":"61204827c1af2367cb0bf389ddd8e46393ea2e0c34ce4d8c001dd789fe9581e6","effective_date":null},{"id":"billing-363f43b1d057dc0a","kind":"hospital_web","url":"https://www.capitalhealth.org/sites/default/files/2026-01/Hospital%20Collections%20and%20Financial%20Assistance%20Policy_2026_ENG.pdf","title":"Hospital Collections and Financial Assistance Policy","fetched_on":"2026-10-10","sha256":"363f43b1d057dc0a5d17434aa052e40cf8c989363253224dfc5a3dbbdf8a1aff","effective_date":null},{"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-2a79206026730732","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":"2a79206026730732b6f7e9b040a4e9a63e486c3733b86fca0f8bf04bc8b874b1","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}