Traducción para entender la carta. Se envía la carta en inglés.

Solicitud de ayuda financiera

Estoy solicitando ayuda financiera. Mi hogar tiene 3 personas y nuestro ingreso anual es $58,000.00, que es el 212.3% de las pautas federales de pobreza (Federal Poverty Guidelines) de 2026.

Su Política de Ayuda Financiera indica un descuento del 90% en este nivel de ingresos.

Se adjuntan el formulario de evaluación financiera completado y los documentos que indica.

English letter, the one that is sent:

SAMPLE — FICTIONAL DATA. NOT A REAL LETTER.

March 2, 2026
To: Patient Financial Services, Seaside Regional Hospital

Application for financial assistance

Dear Patient Financial Services team,

I am applying for financial assistance. My household has 3 people and our yearly income is $58,000.00, which is 212.3% of the 2026 federal poverty guidelines.

Your Financial Assistance Policy lists a 90% discount at this income level. Policy p.11

The completed Financial Evaluation Form and the documents it lists are attached.

Attached: Financial Evaluation Form; Documents listed in Table C of the form.

Sincerely,
Daniela Castillo
9349 Seagrape Ln Apt 717
Bayside, FL 33067
(954) 555-0161
Signature
Where this comes from (for you, not part of the letter)
  • Financial Assistance Policy (current public version), page 11: 201% - 250% of FPG 90% Discount

Rules: the public Financial Assistance Policy and form of Memorial Regional Hospital (FL; MHS = Memorial Healthcare System), applied to the fictional Seaside Regional Hospital case.

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Not legal or medical advice. You review and sign every letter.