1200 North 7th Street, Chariton, Iowa 50049
Phone: (641) 774-3201 | Toll-free: (800) 404-3111
Financial Assistance Program Purpose
To outline and establish policies and procedures in conformance with applicable sections of the Iowa Code and consistent with the mission, vision, and values of Lucas County Health Center to better serve our patients, regardless of their ability to pay, and to provide financial assistance and counseling for those of limited means, without regard to race, ethnicity, gender, religion, or national origin.
No one will be denied access to services due to inability to pay and there are discounts available based on family size and income.
Forms & Documents
Click on links to view, save, or print documents.
English:
- Financial Assistance Policy
- LCHC’s Financial Policy – Plain Language Summary
- LCHC Financial Assistance Application (PDF – print and mail)
- LCHC Financial Assistance Application (submit online)
Russian/русский
- LCHC’s Financial Policy – Plain Language | Политика оказания финансовой помощи — краткое изложение простым и доступным языком
- LCHC Financial Assistance Application | Заявление на участие в программе финансовой помощи
Spanish/Español
- LCHC’s Financial Policy – Plain Language | Política de ayuda económica (resumen en lenguaje sencillo)
- LCHC Financial Assistance Application | Solicitud del programa de ayuda económica
Ukrainian/українець