Your Hospital has partnered with Advomas to help you erase your medical debt. Advomas will help you apply and secure health insurance coverage. We are here to help you every step of the way. You will receive a postcard from your eligibility specialist in the mail. Please call us immediately at Toll Free 877-238-6627.

Forms

Click an icon below to view or download the form(s) you need to complete to begin the process.

/wp-content/uploads/2018/08/Advomas-Authorization-For-Representation-Form.pdf
Authorization
for Representation
/wp-content/uploads/2018/08/Advomas-Release-Of-Information-Form.pdf
Release
of Information
/wp-content/uploads/2018/08/Advomas-Verification-Of-Assets-Form.pdf
Verification
of Assets
/wp-content/uploads/2018/08/Advomas-SS-Release-Form.pdf
Social Security
Release
/wp-content/uploads/2018/08/Advomas-Verification-Of-Employment-Form.pdf
Verification
of Employment
/wp-content/uploads/2018/08/Advomas-Self-Employment-Form.pdf
Self Employment
Form
/wp-content/uploads/2018/08/Advomas-HCCS-Questionnaire-Form.pdf
Healthcare Supplemental Questionnaire
/wp-content/uploads/2018/08/Advomas-Authorization-To-Release-PHI-Form.pdf
Authorization to
Release PHI
/wp-content/uploads/2018/08/Advomas-Retroactive-Medicaid-App-Form.pdf
Retroactive
Medicaid Application
/wp-content/uploads/2018/08/Advomas-Medical-Social-Questionnaire-Form.pdf
Medical
Social Questionnaire
/wp-content/uploads/2018/08/Advomas-Work-History-Form.pdf
Work History
Form