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AHCCCS PATIENTS: If your child/children are currently enrolled in AHCCCS,
you need to bring the patient AHCCCS number or AHCCCS ID card, some form of
identification for yourself, guardianship papers, proof of residence, social
security number, age verification and, if you have private medical insurance,
your insurance card.
ALL OTHER PATIENTS: The following information and verification is
required to complete your Financial Eligibility application. Bring the following
for each member of your immediate family.
Health
Insurance
Guardianship
papers
Proof of
Residency
Social
Security Numbers
Proof of
Child’s Age |
Earnings,
Self-employment
Unearned
Income and Child Support
Child Care
Medical
Expenses: Paid and Unpaid
Identification
for parent or legal guardian |
You may be
asked at the interview to provide additional information.
Clinic Locations
Notice of Privacy
English [PDF 42KB]
(Revised April 14, 2006)
Aviso de Prácticas de Privacidad
Spanish [PDF
51KB]
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