New Patient Enrollment Documentation
Please bring the following documents with you when you come to your enrollment appointment:
For CHP+/Medicaid
The following documents are helpful, but not required:
- Driver's License/State ID
- Birth certificates for all family members applying
- Legal Permanent Resident card
- Medical expenses for last three months if you are requesting retroactive Medicaid coverage
- Health insurance information if applicable
- Business ledgers or profit or loss statement for previous month if self-employed
For Sliding Scale*
- Driver's License/State ID
- Medicaid denial letter if applicable
- Legal Permanent Resident card
- Health insurance information if applicable
- Business ledgers or profit or loss statement for previous month if self-employed
- Proof of income for last month if employed
For Uninsured / Sliding Scale
- Identification card, if applicable
- Business ledgers or profit or loss statement for previous month if self-employed
- Proof of income for last month if employed
