To qualify to become a medical patient, individuals must be:
- A resident in one of the following counties: Indiana- Adams, Allen, DeKalb, Huntington, Kosciusko, LaGrange, Noble, Steuben, Wabash, Wells, Whitley; Ohio- Defiance, Paulding, Van Wert, Williams
- Age: 18 years or older
- Have no medical insurance (including Medicaid, Medicare or HIP)
- Fall at or below 200% of the Federal Poverty Level
Your donations help to cover the costs of providing your care
- Please donate $5 for a medical visit.
To become a medical patient you must register between 8:30 and 11:00 a.m. weekdays and bring all 7 items from the list below:
- 1. Photo identification (drivers license, employee ID, etc.).
- 2. Proof of residence in County supplied by mail in your name and current address (such as a bill or lease). If person is not a U.S. citizen, you must provide a Resident card, Green card, or an Embassy card.
- 3. Proof of all household income for one month:
- 1 month of continuous paycheck stubs (within the last two months) if employed.
- Statement of household income (or lack of income) which includes legal spouse and children under 21 (25 if full time student). If other persons living in the home are contributing financially to the household, their contributions must be declared as income. If you are of age and living at home, with relatives in their home or with another person in his or her home, then you must bring a letter from the person with whom you are living stating that they are not financially responsible for you and that he/she is providing you free room and board.
- Documentation showing your Social Security, Disability, SSI, Unemployment, Pension, Alimony, and Child Support
- 4. Most recent tax return (if filed).
- 5. Proof that you have applied for Unemployment, Medicaid and/or Disability. This can be an application or denial letter from the appropriate agency. Veterans are not accepted as patients unless they furnish a letter from the Veterans Administration declaring their ineligibility for VA benefits.
- 6. Names and address of all physicians, hospitals, etc. that have treated you in the past year.
- 7. The names, dosages, and frequency of all medications you are taking.