Patient Information and Financial Information

The Eric B Chandler Health Center participates in many federal and state-funded programs, including those that provide services to the uninsured and to others on a sliding fee scale based on an individual’s or family’s ability to pay. Many of these publicly-funded programs require that patients register for services and provide information to verify their identification, income and dependents.

Prior to your first visit, review the list below and, based on the information provided, your eligibility for services and payment level will be determined. In addition, the registration information provides the basis for contacting patients and families in case of a medical emergency, abnormal clinical laboratory tests, notification of new services, and changes in operation hours. Review the information below and bring the proper documentation to your first visit to ensure that you are properly registered for care. You will need one from each section.

Proof of Personal Identification:

Driver’s License
Social Security Card
Immigration Registry Card
Birth Certificate
Employee Identification Card
Selective Service Card
Union Membership Card
Voter Registration Card
School Picture Identification Card

Proof of Residence:

Rent Book/Lease
Utility Bill
Mortgage Invoice/Coupon

Proof of Household Income:

Paycheck or Pay Stub
Unemployment Check Stub
Disability Check Stub
Social Security Award Letter/Copy of Check
Child Support Check Stub
Alimony Payment
Most Recent Income Tax Return
Statement of Foster Child Care Benefits

Patients without income are required to bring a signed EBCHC Support Letter from the person providing support.