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Developing
a Healthy Community
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Menu
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HAWC Main
Medical/Dental Clinic HAWC Outreach Medical Clinic 335 Record Street, Suite 250 Reno, NV 89512 ____________ Phone 775-324-2599 Fax 775-324-0724
HAWC Storey County Health Center 175 E Carson Street Virginia City, NV 89440 ____________ Phone 775-284-3570 Fax 775-284-3599
HAWC Administration Office 1450 Ridgeview Drive, Ste 200 Reno, NV 89519 ____________ Phone 775-329-6300 Fax 775-348-3896 |
Sliding Fee Eligibility Checklist
*** Links to forms are at the bottom of this page ***Click here to see the sliding fee scaleNote to patients applying for sliding fee: eligibility is based on your gross annual income and the size of your family.
Para pacientes applicando para el descuento de bajos recursos: La calificacion es basada en sus ingresos anuales y cuantos miembros hay en la familia.
1. Government issued identification card of the head of household. Una identificación del gobierno de la persona responsable.
2. Proof of address. A current utility bill, rent agreement or lease (see Proof of Address documents list) with the name and address of the head of household. Prueba de su domicilio. Cualquier cobro de utilidades, contrato de rentamiento o de alquiler con el nombre y la dirección de la persona responsable.
3. Proof of income. The following may be used to prove gross annual income (calculated from the past 3 months):
Prueba de salario. Los siguiente se puede usar como comprobante de su salario anual (calculado de últimos 3 meces):
Paycheck Stubs (three most current) Talones de cheques (tres mas reciente) Social Security Determination Letter Carta de pensión del seguro social Unemployment determination letter Carta de desempleo
To complete your Sliding Scale Fee Application, it is best to make an appointment with our eligibility specialist in Suite 100. You may schedule this appointment by calling 329-6300 option 3. Please direct question about sliding fee eligibility to 329-6300 x168 or x169. Thank you.
Para completar su applicacion de bajos recursos, es major que hagas una cita para entregar sus documentos en la oficina cuarto #100. Para una cita llame al telefono 329-6300 opcion 3. Si tienes preguntas llamar al 329-6300 x168 0 x169. Gracias.
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| Copyright © 2003-2005 [Health Access Washoe County] - Page Last Updated: 11/16/2011 |
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Basin Primary Care Association