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St. Dominic Hospital Community Benefit Applications

Community Benefit Applications

Please review our mission and vision before submitting an application for community benefits.


 

Based on our most recent CHNA, we invest in these key areas:

  1. Affordable healthcare services for people or families with low income
  2. Domestic violence resources
  3. Prescription assistance
  4. Programs for diabetes and/or obesity
  5. Caring for aging parents and resources to help
  6. Specialty care services
  7. Heart health or cardiovascular health
  8. Primary care services

Required Forms

These are forms that are required to fill out and upload in your Community Benefits Application below.

Ownership Acknowledgement Form

Before filling out the application below, Download, fill, and save this Ownership Acknowledgement Form. It must be submitted as part of the application below.

Supplier Supplement Form

Before filling out the application below, Download, fill, and save this Supplier Supplement Form. It must be submitted as part of the application below.