Billing Information  
Guarantor Name
   Patient Name/Acct Number
Company Name (optional)
First Name
Last Name
Zip Code
Work Phone
E-mail (required for an emailed receipt)
   Payment Information  

Payment Amount
  Please select a payment method
Checking Savings Credit/Debit Card

Payment Policy Notice

Please refer to your billing or statement that you have received in the mail from St. Luke, Home Health or the Hospital. Please read your billing thoroughly for all notices and payment arrangements.

Your billing will list the correct account number(s) that you will enter into the patient account number. Please use the free text note section to supply additional information specific to your account(s) such as the provider of the service, i.e. clinics, home health, home medical equipment or hospital.

Please list the name of the person making the payment and their current address and phone number. This number will be used to make contact if we can not identify the correct account.

Please refer all your billing questions to the business office at 620-382-2177, or email us at

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