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• identification (see Acceptable Proof of Identification below)
• Indian River County residency (see Acceptable Proof of Indian River County Residency below)
• household income (see Acceptable Proof of Household Income below)

If you choose to have your eligibility determined, our eligibility staff will assist you with the eligibility determination process, including what information we need from you.  If you choose not to have your eligibility determined (waived eligibility), you will be responsible for paying the full fee for any medical service you receive that has a fee associated, including fees not covered by insurance.

Eligibility for NEW Patients
If you are a new patient seeking reduced medical fees on a sliding fee scale, you will be given 45 days of Temporary Financial Eligibility at your first clinic appointment. Please bring your photo ID and Two Proofs of Residence to this appointment. This will determine your Temporary Sliding Fee Scale. You must make an Eligibility appointment within those 45 days and meet Eligibility requirements to determine if you will be eligible to receive services on the Sliding Fee Scale. If you don’t meet the requirements within the 45 days, your fees will be set at 100% and you will be responsible for paying the full fee for any medical service received, including any amount insurance does not cover. If your status changes, you can contact our Eligibility office to update your Eligibility to see if you qualify for reduced rates

Eligibility for EXISTING Patients
Patients already receiving reduced medical fees on a sliding fee scale will need to make an appointment with our Eligibility Office to have your eligibility re-determined before the end of the 6 months to determine if you are still eligible.  If you don't meet the eligibility requirements, or if you don't provide the necessary information before your re-determination date expires, your eligibility will end and you will then be responsible for paying 100% of any medical fees charged, including any amount insurance does not cover.  While eligibility is re-determined every 6 months, you should contact us anytime your information changes.

Eligibility for Dental Services
Our dental services are limited to those who are less than 200% of the Federal Poverty Level (FPL) according to income verification.  Proof of identification, residency and income requirements as noted below apply.  Medicaid is accepted.

What if I don't Want to Go Through the Eligibility Process for Reduced Medical Fees?
You can choose not to have your eligibility determined, in which case, your eligibility will be waived and you will be responsible for paying the full fee for any medical service you receive that has a fee associated, including any fees not covered by insurance. 

Some Fees for Medical Services May Depend on Specific Individual Situations or Are Not Offered on the Sliding Fee Scale.  These services include:

• Family planning/birth control/contraceptives (fee varies)
• Childhood immunizations 2 months through age 18 (free if eligible through Vaccines for Children program)
• Travel immunizations (full fee for service)
• Adult immunizations, if here only for this service (full fee for service)
• School/work physicals (fee varies)
• Sexually transmitted disease (STD) testing, treatment and counseling (fee varies)
• Tuberculosis/communicable disease control (fee varies)

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• Any official local, state or federal government or military issued ID with photo, for example:
       - Driver's license
       - Government ID
       - Valid passport (US or non-US)
• Valid work ID
• Valid school ID

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• Any official valid local, state, federal government or military issued document
• A bill within the last 60 days with your name and address listed from any of the following:
  - electric bill
  - water bill
  - gas bill
  - cable bill
  - satellite bill
  - medical bill (not from the health department)
  - pest control bill
  - home phone bill
  - cellular phone bill
• Credit card or insurance statement within last 60 days
• Recent pay stub within last 60 days
• Voter registration card
• Housing/mortgage agreement
• Rental agreement/lease (with landlord's name/address/phone #)
• Previous month's rental receipt (with landlord's name/address/phone #)
• Prior year property tax receipt or current year's property tax bill
• W-2 form for previous year
• Unemployment document within last 60 days
• Vehicle registration for current year
• County school record/registration certificate showing current enrollment in school
• For incarcerated individuals, residency will be established by residency immediately prior to incarceration
• Homeless individuals must bring in one of the following:
  - homeless declaration signed by agency personnel
  - law enforcement booking sheet
  - declaration letter from family or friend
  - letter of support (contact Eligibility Office for further information)

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• Another family, other than yours, that lives in the same house you live in
• Any single adult over 18 living with relatives is considered to be a separate family, unless the adult is a member of a separate economic unit

Wages and Salary:

• Pay stubs

• Letter from employer(s) on company letterhead signed and dated by your employer (with their name/address/phone #) showing gross earnings

• 1040 ES quarterly tax form (dated within 90 days from eligibility determination)

• 1040 form or W-2 form for the past year

• Gross income from self-employment

• Most recent income tax return

Unearned Monthly Income:

• Social security and disability benefits

• Public assistance or welfare payments

• Unemployment compensation

• Spousal support (alimony) received

• Worker's compensation for lost income

• Court ordered child support received or paid

Other Unearned Income (figured monthly):

• Veterans and military allotments

• Retirement and pension benefits

• Insurance, annuity, estate or trust income

• Private loans that recur

• Dividends or interest on savings, stocks/bonds

• New rental income and royalties

• Contributions

• Savings, investments, trust accounts and other resources readily available to the household

• Letter of Financial Support (contact Eligibility Office for further information)

Expenses (figured monthly):

• court ordered child support

• child or day care expenses

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