New Patient Enrollment

Enter:

First Name (of the responsible party as stated on your hospital bill)
 
Last Name (of the responsible party as stated on your hospital bill)
 
Responsible Party's Date of Birth  
 
Account Number (This could be stated on your hospital bill as "HAR number", "Occurrence number" , "Voucher number", "Invoice number", or "Account number".)
   

Click here

to learn about the privacy guidelines HELP uses regarding your information.
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