Gold Card Application Form Houston Texas

Answer 1 of 6. How to Obtain a Gold Card for Medical Reasons in Houston Texas.

Gold Card Application Harris Health Fill Online Printable Fillable Blank Pdffiller

Box 300488 houston tx 77230.

Gold card application form houston texas. Download application form for harris county gold card for FREE. The Harris Health System is not free but there is financial assistance for those who qualify. How long is the application process.

Ocial Security card Medicaid card Medicare card C. By providing these six items you will help ensure your Gold Card application goes. Dec 26 The only ways to apply for Gold Card are visiting a Harris Health eligibility center or completing the Gold Card application and then mailing it back to them.

If you are self-employed you will need your most recent IRS 1040 formand. Print the two-page application from the Harris County Hospital District website. November 2017 GOLD CARD APPLICATION RENEWAL You can mail out the documents to.

Program harris health system financial assistance gold card description provides financial assistance for those who qualify this has traditionally been known as the harris county gold card while. Gold card application houston tx. There are two ways to obtain a Gold Card application.

Family Houston Case. If you have access to a printer use this link DOWNLOAD YOUR GOLD CARD APPLICATION If you do not have access to a printer you can pick up a copy at any Harris Health or City of Houston Eligibility Center. All 3 levels are eligible to receive a Gold Card.

You are encouraged to print two copies of the Harris Health Gold Card application form. Box 300488 Houston TX 77230. All formats available for PC Mac eBook Readers and other mobile devices.

Identification of you and if applicable your. Monday-Friday 7 am-4 pm. The application form is 2 pages front and back that should be either mailed or dropped off to any of the 5 eligibility centers in the greater Houston area.

HARRIS HEALTH THE GOLD CARD HOW TO APPLY. A Harris County Gold Card may be obtained by applying to the Harris County Hospital District. The first page is the application instruction form which outlines all documentation needed to apply for a Gold Card.

Please fill out the form with your patient. Box 300488 Houston TX 77230 Or you may drop off your completed application and proof documents in the eligibility drop box at the following locations at the front door of each health center. In order to obtain a Texas Harris County Gold Card you will first need to download an application formSelect the language required below English Spanish Vietnamese Eligibility In order to prove eligibility for a Texas Harris County Gold Card you will have to indicate proof within the following seven categoriesPersonal proof of identification ID and proof of ID of family.

If you are uninsured the Harris Health System is a way for you to find affordable sliding-scale healthcare. AcresHome Eligibility Center 281 447 6002. Staff of the Harris County Hospital District will need to decide which patients will qualify for subsidized care due to financial need or other circumstances.

Please Provide Harris Health copies of. If you have any questions or need further assistance with your HCAP Application please contact us at 936 523-5100. Benefit record Income on SNAP form TF0001 Harris Health System-Statement of Self Employment Income Form if no tax return is filed.

Depending on your household income you could qualify for medical assistance that helps to alleviate the cost of medical. Acres Home Health Center 818 Ringold St Houston TX 77088 Hours. Apr 07 Take or mail your application and supporting.

The Gold Card application form is two pages front and back. For renewal applicants except for Medicare applicants if your name address marital or legal status household member health coverage have not changed since the last expiration please complete submit the application. This form allows Harris Health to share your health information requested by drug manufacturers and to sign other forms that are necessary to complete your application if you qualify for assistance.

Download application form for harris county gold cardpdf. Answer 1 of 10. If eligible applicants receive a discount gold card to cover medical services at county clinics and hospitals at minimal to no cost.

Completing the application online would be far easier for most but at this point thats not an option. At this point there is no way to apply for the service over the Internet but this may change in the future. Harris Health Financial Assistance Program PO.

Program MAP Consent and Authorization Form 283233. Urrent IRS 10401040A tax return all pages if self- employed Veteran Affairs letter or check Agency letter U. The Harris Health System previously called the Gold Card helps people with low or no income get quality health care.

6654 Hornwood Houston TX 77074. PDFAdobe Acrobat - Afficher Below are some helpful tips with regards to obtaining a Gold Card. Harris Health Financial Assistance Program PO.

Applicants should receive confirmation of their application within 10 days and notification of. Applicants are highly encouraged to mail their forms to the eligibility office as the entire process will be expedited but 5 eligibility centers exist where patients can drop off forms.

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