The Physicians Bill is addressed to the "guarantor" - usually the patient's parent or another person responsible for paying for care.
This is the first page of a multi-page bill.
This provides your original statement date, information about the prompt pay discount, and the way payments are applied to accounts.
This amount reflects charges for all the children in the family receiving care.
If eligible, prompt pay discounts may be listed here.
Payment arrangements and customer service.
As of November 2012, CHOP patient families can pay their bills online. Go to www.chop.edu/billpay for instructions.
If personal information is incorrect (name, address, telephone number, or insurance coverage), check this box and fill out the back of this coupon.
On the payment coupon, indicate the amount you are sending. If paying by credit or debit card, please complete all sections.
If paying Bill by check, please make payable to CHOP.
The signature code is on the back of your card, on the right-hand side of the signature area.
Send Hospital Bill payments to this address, and include the completed coupon.