New Patient Enrollment Documentation

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 Colorado Indigent Care Program (CICP)*

• CO Driver's License/CO 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 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