WellSpan Ephrata Community Hospital PatientPortal.me
WellSpan Ephrata Community Hospital
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Personal Info
If you're a WellSpan Ephrata Community Hospital Employee please check the box provided below.
Enter your employee number and department in the boxes provided.
Employee Number:* Department:*
  • It is the employee's responsibility to send his or her bills along with the appropriate statement(s) and form to Patient Financial Services for processing of discounts.
  • Employees may send their bills and forms through interdepartmental mail, taking care to seal the envelope securely and designate as "Confidential".
  • Employees should allow three to five (3-5) days for processing.
  • Employee Discount Request Forms may be obtained in the Hospital outside the Cafeteria next to the Human Resources bulletin board or in the Human Resources Department.
  • After making your payment please note your payment transaction ID on your Employee Discount Request Form.

If your payment due date has exceeded the eligible discount date, please remit payment in full.
Patient Name:* Payment Amount:* $
Account Number:* What is this? Re-enter Account Number:*
Phone: Email:*
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Recurring Payments
Patient Name:* Payment Amount:* $
Account Number:* What is this? Re-enter Account Number:*
Patient Name:* Payment Amount:* $
Account Number:* What is this? Re-enter Account Number:*
Patient Name:* Payment Amount:* $
Account Number:* What is this? Re-enter Account Number:*
Patient Name:* Payment Amount:* $
Account Number:* What is this? Re-enter Account Number:*
Net Amount: $
Preferred Payment: $
Select Time Frame:
Today's Payment: $
 
Payment Options
Please select your payment method:
NOTE: ACH and E-Checks can take up to 7 days to process and post to your patient account. Any payments not posted to your patient account by the due date may be sent to collections. You are hereby requesting and authorizing an electronic transfer from your bank account as a form of payment.
Routing Number: *
Check Number:*
Account Number: *
Account Type: *
Enter your Credit Card information
Card Number:*
Card Type:*
Expiration Date:*
CVV2:* What is this?
TRN NBR:* ?
Billing Info
Enter the Cardholder's Billing information: Enter the Payer's Billing information:
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:* :*
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Payment Summary
Payment Amount: $0.00
Handling Fee: $0.00
Total amount payable: $0.00
Mode of Payment: Credit Card