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Eligibility

  1. Uninsured
  2. Underinsured
  3. Income

Required Documentation

PHOTO ID: Current identification

PROOF OF INCOME:  Total household income is required. Acceptable documents may be pay stubs, letters from Social Security, Department of Welfare, Pension, or disability offices stating what the patient receives.  The previous year’s income tax return or proof of non-filing your taxes (4506T) will also be required

PROOF OF RESIDENCY: Any documentation that verifies your residency. (rental agreement, utility bill, etc.)

MEDICAL ASSISTANCE DENIAL LETTER:   All patients will be required to obtain a denial letter from the Welfare Office.  To apply for Medical Assistance, visit the COMPASS website.

Exceptions

  1. Active duty military members and their families.
  2. Volunteer and employees of nonprofit agencies that do not provide insurance.
  3. As determined by the Executive Director or Medical Director.
  4. Patients who are referred from other agencies.
  5. Patients with recent hospital discharge.
  6. Pre-employment physicals.
  7. Vaccines and immunizations.
  8. Hep-C, HIV, STD testing.
  9. Soft Tissue inspection.
  10. Harm reduction participants

Any Questions regarding eligibility, please call our office at (814)534-6242.

Eligibility

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f4506t

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Patient-Health-Information_UPDATED-20141

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Patient-Demographic-Sheet_-UPDATED20144

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