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Welcome to the CRMC Online Payment Center. You may pay your hospital bills here by credit card. We do have financial assistance available to those who qualify, please call 620-252-1549 for more information. |
For your convenience please complete the payment form below. All information will be kept secure and confidential. For more information you may call our business office during working hours at 620-252-1549.
You may make payments to the Hospital using your credit card information in the fields below. All payments are via secure server. Thank you for allowing us to serve you.
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Name Of Patient Name of Patient Treated. |
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Account Number Account Number. The account number(s) is located on the top of your statement. You may enter up to 3 account numbers. Example: V900506 for hospital payments and 3 or 4 digit number for Clinic payments |
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Name of Payor Payor's Name on Credit Card |
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Billing Address Address Where Your Credit Card Statements Are Mailed. |
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City, State, Zip Please Include Your City, State, and Five Digit Zip Code. |
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Payor Phone Number Please give us a phone number where you can be reached during the day. |
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Your E-Mail Address Please Provide An E-mail Address. |
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Amount of Your Payment Please Specify How Much You Are Paying. Please Use Dollars and Cents. |
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Credit Card Type Select If You Are Paying By Credit Card. |
Visa MasterCard American Express Discover |
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Credit Card Number Input The 16 Digit Number Just As It Appears On Card. |
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Credit Card Expiration Date Example: 00/00 |
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Comments Or Messages Related To Your Payment |
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