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East Adams Rural Healthcare

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay your hospital bills here by credit/debit card.
For your convenience please fill out the below payment form. All information will be kept secure and confidential. For more information you may call our business office during working hours.

You may make payments to the Hospital submitting your credit card information in below fields.

All payments are via secure server. Thank you for allowing us to serve you.


* Account Number
* Name Of Patient
Name of Patient Treated.
* Credit Card Type
Select If You Are Paying By Credit Card.
  Comments Or Messages Related To Your Payment
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Email Address
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code