CENTRAL AREA DENTAL CLINIC. Mabuhay!

Size: px
Start display at page:

Download "CENTRAL AREA DENTAL CLINIC. www.neighborcare.org. Mabuhay!"

Transcription

1 CENTRAL AREA DENTAL CLINIC Mabuhay!

2 Mabuhay! Mabuhay! Welcome to Central Area Dental Clinic Dental Services / Central Area Dental Clinic provides ongoing and urgent dental care for children and adults. Some of the services we offer include: n Dental exams, cleanings, X-rays, fillings and extractions n Oral health education n Limited oral surgery, as well as limited crown, denture and root canal services Thank you for choosing Neighborcare Health Central Area Dental Clinic Neighborcare Health is committed to creating a health care home, encouraging longterm relationships between patients and providers that include medical, dental and mental health care. This means offering medical care as well as dental care, mental health services, health education and other services to care for the whole person. To keep your mouth healthy, we want to see you regularly for your dental check-ups and care. To continue to be a patient of record at Neighborcare Health, you must be seen at least every two years. By choosing Central Area Dental Clinic, you become an important part of our health care team. We encourage our patients to be actively involved in their own health, ask questions and take an interest in getting well and staying well.

3 Emergencies and After-Hours Care Appointments Hours: We are open Monday through Thursday from 7:15 a.m. to 6:00 p.m. We are closed most federal holidays. Children and some adult groups are the first priority for limited appointments. To establish or continue ongoing care, please call If you are going to be late to your appointment, please call as soon as possible - we may have to reschedule you. If you are going to miss your appointment, please call ahead so we can make your appointment time available for someone else. We require 24 hours or one business day notice to cancel or change an appointment. We will be happy to schedule you at another time. We offer walk-in hours for urgent care needs, Monday through Thursday starting at 7:15 a.m. If you have a dental emergency, call our main number: If time permits, we try to treat all emergency patients each day. Emergency patients must arrive at the clinic 90 minutes before the clinic closes. Children who need emergency care or any patient with visible swelling or trauma are given first priority. If our clinic is closed, you will be referred to the Harborview Community Care Line. If needed, an on-call dentist will be called. Interpreter Services Patients speaking more than 45 different languages and dialects visit our clinics. We have interpreters and other staff members at our clinic sites who speak Somali, Spanish, Vietnamese and many other languages. When needed, we also provide interpretation services in other languages through a contracted agency.

4 If you are uninsured: We ask all uninsured patients to make an appointment with an Eligibility Specialist to learn if you qualify for public insurance through the Affordable Care Act (Obamacare) and the Washington Healthplanfinder. Enrollment is much more efficient if you can bring all the information we need at the time of your appointment. Please bring the following documents to your eligibility appointment: What to Bring: If you are a new patient: Please bring any written records of your medical care outside of Neighborcare Health. Also, please bring the following: n Immunization records for you and/or your child. n Any medications you are currently using. n Your insurance card or ProviderOne card. If you have no insurance, you may be eligible for public insurance or discounted services through Neighborcare Health. Income and Family Size Verification: n 1040 Federal Tax Form (most recent year). OR n Pay stubs from the past 30 days showing gross income, or one of the following: Award or benefit letter (if receiving income from other sources, e.g. L&I, child support, unemployment). Employer letter stating your gross income. Last two unemployment check stubs (if receiving unemployment). A letter of support or reference from an organization or individual. n Employer(s) name address. Identity and Residence Verification: n If you are a US citizen, please bring Social Security numbers and names of family members to be enrolled. n A current photo ID such as driver s license, stateissued identification card, or military ID. If your current address is different from your ID, we will need a utility bill, rental contract or a letter with your name and the current address. n If you are a naturalized citizen, please bring your naturalization certificate. n If you are a legal immigrant, please bring a green card and social security cards for all family members. n If you have passports, bring those as well. n An address, if available. n Birth dates, including the year, for all family members.

5 Fees and Insurance We believe that quality health care should be available to everyone, regardless of ability to pay. We accept Provider One and most types of insurance. Payment for services or proof of insurance is expected at time of service. This includes co-pays. We accept cash, checks, Visa, MasterCard, American Express and Discover. We ask all uninsured patients to meet with an Eligibility Specialist to determine if they are eligible for public insurance through Washington Healthplanfinder or a sliding fee discount from Neighborcare Health. The sliding fee discount is available for low-income patients who are not eligible for public insurance. To qualify, a patient must meet with an Eligibility Specialist at one of our clinics. Once a patient qualifies for a sliding fee discount, the minimum fee for a dental appointment is $45. We offer an additional $5 discount if the fee is paid at the time of your appointment. If you are uninsured and choose not to apply for public insurance or the sliding fee discount, we ask you to pay a deposit to defray the initial cost of your care. The dental ($90) deposit will be discounted to $85, if paid at the time of service. Neighborcare Health patients are billed directly by LabCorp for any lab tests and services, and are responsible for paying LabCorp directly. Neighborcare Health informs LabCorp directly if a patient is eligible for the sliding fee discount. Patients with questions or concerns about a current bill are welcome to contact our patient accounts department at Neighborcare Health is a non-profit organization. Public grants and insurance reimbursement cover only a portion of our expenses. Even a small tax-deductible gift can help cover the unmet need to care for a patient. thank you! Patient Rights and Responsibilities As a patient of Neighborcare Health You have the right to: n Care and service With privacy and confidentiality, That respects your beliefs and values, In a safe, secure, comfortable and clean environment. n Information about: Our services and providers, Your health and proposed treatments, How to provide positive and negative comments about your care. n Participate in decisions about your health care treatments and procedures. n Language assistance services. You have the responsibility to: n Provide complete information about your health history and current health. n Participate in decisions about your health care treatments and procedures. n Follow the treatment plan developed with your provider or inform your provider if you cannot follow through. n Treat Neighborcare Health staff, patients and property respectfully. n Make and keep appointments and notify the clinic if you are going to be late or need to cancel an appointment. n Pay the bills and fees for the health care services provided to you. Neighborcare Health does not discriminate against any person on the basis of race, ethnicity, national origin, religion, age, marital status, gender, sexual orientation, political affiliation, or presence of a sensory, mental or physical handicap.

6 We re in your neighborhood th Street Medical & Dental Clinic 1629 N 45th St, Seattle, WA th Street Homeless Youth Clinic 1629 N 45th St, Seattle, WA Bailey Gatzert School-Based Health Center 1301 E Yesler Way, Seattle, WA lake city 4. Ballard Homeless Clinic Nyer Urness House 1753 NW 56th St, #200, Seattle, WA Northgate 5. Central Area Dental Clinic 2101 E Yesler Way, Seattle, WA Chief Sealth International School-Based Health Center 2600 SW Thistle St, Seattle, WA Dearborn Park School-Based Health Center 2820 S Orcas St, Seattle, WA Denny International School-Based Health Center 2601 SW Kenyon St, Seattle, WA Georgetown Dental Clinic th Ave S, Seattle, WA Greenwood Medical Clinic 415 N 85th St, Seattle, WA High Point Medical & Dental Clinic th Ave SW, Seattle, WA Highland Park School-Based Health Center 1012 SW Trenton St, Seattle, WA Lake City Medical Clinic th Ave NE, #101, Seattle, WA Madison School-Based Health Center th Ave SW, Seattle, WA McDermott Place Medical Clinic rd Ave NE, #200, Seattle, WA Mercer School-Based Health Center 1600 S Columbian Way, Seattle, WA Pike Market Medical Clinic 1930 Post Alley, Seattle, WA Rainier Beach Medical & Dental Clinic 9245 Rainier Ave S, Seattle, WA Rainier Park Medical Clinic th Ave S, Seattle, WA Roosevelt School-Based Health Center 1410 NE 66th St, Seattle, WA Roxhill School-Based Health Center th Ave SW, Seattle, WA Van Asselt School-Based Health Center 8311 Beacon Ave S, Seattle, WA West Seattle Elementary School-Based Health Center th Ave SW, Seattle, WA West Seattle School-Based Health Center 3000 California Ave SW, Seattle, WA

7 Neighborcare Health is the largest provider of primary medical and dental care in Seattle for low-income and uninsured families and individuals, serving our community for more than 40 years. Mabuhay! CENTRAL AREA DENTAL CLINIC 2101 E. Yesler Way (2nd floor), Seattle, WA Phone: Fax: PHOTOGRAPHY BY DJORDJE ZLATANOVIC JANUARY 2014

LAKE CITY MEDICAL CLINIC. www.neighborcare.org. Mabuhay!

LAKE CITY MEDICAL CLINIC. www.neighborcare.org. Mabuhay! LAKE CITY MEDICAL CLINIC Mabuhay! www.neighborcare.org Mabuhay! Mabuhay! Welcome to Lake City Medical Clinic Medical Services / 206-417-0326 We provide a range of primary care health services for men,

More information

3000 California Ave. SW, Seattle, WA 98116 Phone: 206-658-8048. www.neighborcare.org

3000 California Ave. SW, Seattle, WA 98116 Phone: 206-658-8048. www.neighborcare.org 3000 California Ave. SW, Seattle, WA 98116 Phone: 206-658-8048 www.neighborcare.org Welcome! Neighborcare Health at West Seattle High is a fullservice health clinic that provides medical and mental health

More information

How To Get A Free Dental Checkup At Access Community Health Centers

How To Get A Free Dental Checkup At Access Community Health Centers Welcome from Ken Loving, MD Chief Executive Officer I extend a warm welcome to you from all of us at Access Community Health Centers. We are happy that you have chosen us as your dental health partner

More information

CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE

CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE Prepared by: Seattle-King County Dental Society 2201 Sixth Avenue, Suite 1210 Seattle, WA 98121-1857 206.443.7607 skcds@skcds.com www.skcds.org CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE Public

More information

CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE

CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE Prepared by: Seattle-King County Dental Society 2201 Sixth Avenue, Suite 1210 Seattle, WA 98121-1857 206.443.7607 skcds@skcds.com www.skcds.org CLINICS AND PROGRAMS PROVIDING REDUCED COST DENTAL CARE Public

More information

Welcome! A few things you need to know about being our patient.

Welcome! A few things you need to know about being our patient. Welcome! A few things you need to know about being our patient. Our Programs and Locations Our Medical and Behavioral Health Programs: In Jefferson County: We see children in our pediatric office, school-aged

More information

Dental Resources. 1629 N 45 th St. Seattle, WA 98103. 126 Auburn Ave.#100 Auburn, WA 98002. 2101 E Yesler Way Seattle, WA 98122

Dental Resources. 1629 N 45 th St. Seattle, WA 98103. 126 Auburn Ave.#100 Auburn, WA 98002. 2101 E Yesler Way Seattle, WA 98122 Dental Resources Community Resource Phone Address Notes 45 th St. (206) 633-3350 X3021 1629 N 45 th St. Seattle, WA 98103 Serves all ages with limited access but primary focus in on children under 18 &

More information

Oral Health Program. Directory of Dental Access Programs. North Dakota Department of Health. Safety Net Dental Clinics.

Oral Health Program. Directory of Dental Access Programs. North Dakota Department of Health. Safety Net Dental Clinics. North Dakota Department of Health Oral Health Program Directory of Dental Access Programs October 2013 The North Dakota Department of Health s Oral Health Program does not run dental clinics in the state,

More information

MassHealth Dental Benefit Booklet

MassHealth Dental Benefit Booklet MassHealth Dental Benefit Booklet January 2012 3 Serving the MassHealth Program* January 2012 Dear MassHealth Member, We have some important news about the MassHealth dental program that you need to know.

More information

Seattle Indian Health Board Patient Handbook

Seattle Indian Health Board Patient Handbook Seattle Indian Health Board Patient Handbook 1 About the Cover Art Work Swansk Halait were highly respected people because of their ability to heal the sick. The healers used traditional Rattles, Dances

More information

STATEMENT OF PRIVACY PRACTICES

STATEMENT OF PRIVACY PRACTICES STATEMENT OF PRIVACY PRACTICES We, at Seattle Smile Works, are dedicated to protect the privacy rights of our patients and the confidential information entrusted to us. The commitment of each employee

More information

You and Access Partners in Health Care

You and Access Partners in Health Care Welcome from Ken Loving, MD Chief Executive Officer I extend a warm welcome to you from all of us at Access Community Health Centers. We are happy that you have chosen us as your health care partner and

More information

How to Use your Card:

How to Use your Card: Our team at Morgan Dental Associates, PLLC has designed a new way to access the dental benefits that will help maintain oral health and keep the healthy smile that you always desire. The Morgan Dental

More information

Important! How the Affordable Care Program works

Important! How the Affordable Care Program works Important! How the Affordable Care Program works What is the Affordable Care Program? The Program allows us to offer patients a sliding fee scale, depending on household income. You share the costs of

More information

I have received a copy of the Notice of Privacy Practices True Health.

I have received a copy of the Notice of Privacy Practices True Health. Sign-in Time: I have received a copy of the Notice of Privacy Practices True Health. Signature of Patient/Patient Representative Relationship of Patient Representative to Patient 2400 State Road 415 11881-A

More information

Winnipeg Regional Health Authority / Oral Health Program

Winnipeg Regional Health Authority / Oral Health Program Winnipeg Regional Health Authority / Oral Health Program September 2013 TABLE OF CONTENTS How To Use This Booklet... 4 Frequently Asked Questions Where to go... 5 Accidents and Emergencies... 6 Where To

More information

When you arrive for your first appointment, please bring the following with you:

When you arrive for your first appointment, please bring the following with you: 115 N. Sumter Street, Suite 400, Sumter, SC 29150 Phone (803) 774-7425 (SICK) / Fax (803) 774-9426 www.cfmsumter.com WELCOME We are honored that you have chosen Carolina Family Medicine of Sumter for your

More information

Current Status: Active PolicyStat ID: 1361644. Financial Assistance/Charity Care

Current Status: Active PolicyStat ID: 1361644. Financial Assistance/Charity Care Current Status: Active PolicyStat ID: 1361644 Original Approval: 8/17/2001 Approval: 2/6/2015 Next Review: 1/30/2016 Owner: Jonathan Tingstad: VP & Chief Financial Officer Policy Area: Finance References:

More information

Frequently Asked Questions (FAQs)

Frequently Asked Questions (FAQs) Cisco Systems LifeConnections Dental Center Frequently Asked Questions (FAQs) December 2013 Contents General 1. What is Cisco s LifeConnections Health Center?... 3 2. What dental care services are available

More information

Medicaid/Texas Health Steps Health Care Orientation English Language Version for Group Setting DRAFT ~ 11_5_01

Medicaid/Texas Health Steps Health Care Orientation English Language Version for Group Setting DRAFT ~ 11_5_01 Welcome to [choose one] today s/tonight s introduction to Medicaid health care. My name is, and I work with. I will [choose one] today/tonight provide you with some information to make the Medicaid program

More information

OUR PRIMARY CONCERN IS YOU!

OUR PRIMARY CONCERN IS YOU! OUR PRIMARY CONCERN IS YOU! Medical Home Patient Care Guide Our Mission To be a caring, compassionate and viable community health center, proactively improving the lives of those we serve by providing

More information

Apply for Free and Reduced Price Meals OR Prepay for Meals Online!

Apply for Free and Reduced Price Meals OR Prepay for Meals Online! Stafford County Public Schools Apply for Free and Reduced Price Meals OR Prepay for Meals Online! Dear Parent/Guardian, Stafford County Public Schools Is pleased to announce the availability of applying

More information

Am I eligible to enroll in the Delta Dental of New Jersey Yale Graduate & Professional Student dental plan?

Am I eligible to enroll in the Delta Dental of New Jersey Yale Graduate & Professional Student dental plan? FAQs Dental Plan Am I eligible to enroll in the Delta Dental of New Jersey Yale Graduate & Professional Student dental plan? A: You must be a Yale University Graduate or Professional student enrolled at

More information

ORAL HEALTH RESOURCE GUIDE Carroll County Health Department 290 South Center Street Westminster, MD 21157 2011-2012

ORAL HEALTH RESOURCE GUIDE Carroll County Health Department 290 South Center Street Westminster, MD 21157 2011-2012 ORAL HEALTH RESOURCE GUIDE Carroll County Health Department 290 South Center Street 2011-2012 (Clients are encouraged to seek dental services with private dental practices in Carroll County. However, this

More information

Dental. Resource Guide

Dental. Resource Guide Dental 2011 Resource Guide TABLE OF CONTENTS Afforadble Dentures Children s Health Insurance Program (CHIP) College Dental Clinic Community Health Connect Medicaid Mobile-Dentistry.org Mountain Ridge Dental

More information

TrueCare Washington. You re not going to drill if you don t have to? THE POLICY PROVIDES DENTAL BENEFITS ONLY.

TrueCare Washington. You re not going to drill if you don t have to? THE POLICY PROVIDES DENTAL BENEFITS ONLY. You re not going to drill if you don t have to? TrueCare Washington Form No. 005IWA(8/14) Policy Form No. 001TRUE-WA(1/14) THE POLICY PROVIDES DENTAL BENEFITS ONLY. Personal care for your individual needs

More information

3. Explains when and how you or your provider may ask for an exception to the limits.

3. Explains when and how you or your provider may ask for an exception to the limits. April 1, 2012 Dear Valued UPMC for You Member: UPMC for You will be making some changes to your dental benefits. These changes will begin May 1, 2012. The enclosure explains the changes to your benefits.

More information

Quality Coverage Made Simple

Quality Coverage Made Simple Individual Plan Quality Coverage Made Simple Dental care that meets your needs Reduced out-of-pocket expenses Simplicity of service This is what you get with DentalOne the Regence BlueShield dental plan

More information

OFFICE POLICIES, EFFECTIVE October 19, 2009

OFFICE POLICIES, EFFECTIVE October 19, 2009 Thank you for choosing our office for your medical care. We have written these policies to keep you informed of our current office policies. Please refer to our website for policy updates. OFFICE POLICIES,

More information

SEATTLE/KING COUNTY CLINIC PATIENT HEALTHCARE RESOURCE LIST KING, PIERCE & SNOHOMISH COUNTIES

SEATTLE/KING COUNTY CLINIC PATIENT HEALTHCARE RESOURCE LIST KING, PIERCE & SNOHOMISH COUNTIES SEATTLE/KING COUNTY KING COUNTY 45TH ST 1629 N 45th St Seattle, WA 98103-6701 206-633-3350, D, Ph, P, Hom, MBC, STD,, DDD ACCESS TO BABY & CHILD DENTISTRY PROGRAM Public Health -Seattle & King Co 401 Fifth

More information

Colorado Medical Assistance Program

Colorado Medical Assistance Program Colorado Medical Assistance Program Colorado Department of Health Care Policy & Financing Using General Fund Dollars to Expand Medicaid Access Amy Scangarella Children s s Policy Specialist Using General

More information

Expanding Health Care Coverage among Alexandria s Children: A Technical Assistance Guide for ACPS Administrators and School Support Teams July 2013

Expanding Health Care Coverage among Alexandria s Children: A Technical Assistance Guide for ACPS Administrators and School Support Teams July 2013 Expanding Health Care Coverage among Alexandria s Children: A Technical Assistance Guide for ACPS Administrators and School Support Teams July 2013 Prepared by the ACPS School Health Advisory Board for

More information

Patient Registration Form

Patient Registration Form 900 Carillon Parkway Suite 404 St. Petersburg, FL 33716 727-572-1333 727-572-1331 fax www.spencerdermatology.com Patient Registration Form Today s : Name: Suffix First Middle Last of Birth: / / Age: Sex:

More information

Business Name : Crystal Dental

Business Name : Crystal Dental Business Name : Crystal Dental Address : 7812 Warner Ave, Huntington Beach, CA, 92647 United States Phone no : (714) 841-4700 FAX : (714) 847-1704 Business Mail : crystaldentalhb@gmail.com Website : http://crystaldentalcenters.com

More information

Health Insurance 101. health insurance. How to make the most. out of your. Caltech Graduate Student Council Health committee

Health Insurance 101. health insurance. How to make the most. out of your. Caltech Graduate Student Council Health committee Caltech Graduate Student Council Health committee How to make the most out of your health insurance Health Insurance 101 Date: Tuesday, May 9 th Time: noon-1pm Place: 2 nd Floor Winnett How does the

More information

Facts About Dentists and Insurance

Facts About Dentists and Insurance Welcome TO THE PRACTICE Patient Information Date Name Birthdate SS# Address City/State Zip Code Driver s License # Name of Employer Check appropriate box Minor Single Married Divorced Widowed Contact Numbers

More information

The exclusive prescription, dental and health discounts program free to NACo member counties

The exclusive prescription, dental and health discounts program free to NACo member counties The exclusive prescription, dental and health discounts program free to NACo member counties Live Healthy the discount program that puts wellness and people first Going the extra mile for your county s

More information

Grant money available for minor home repairs

Grant money available for minor home repairs FOR IMMEDIATE RELEASE Oct. 1, 2014 Contact: Sandy Lila, Neighborhood Improvement Coordinator slila@nlauderdale.org or 954-597-4745 Grant money available for minor home repairs We all got em. Pesky home

More information

Monday between 1:00 pm - 4:00pm

Monday between 1:00 pm - 4:00pm Attention: Tempe and ountain Hills Residents UTILITY ASSISTANCE PROCESS Income eligible Tempe and ountain Hills residents can apply for financial help with electricity, including M-Power and gas bills.

More information

Patient Finance Services Policy

Patient Finance Services Policy Patient Finance Services Policy CONEMAUGH HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY I. PURPOSE Conemaugh Health System is a community of persons committed to being a transforming, healing presence in the

More information

You will need to mail or fax us copies of items that apply to your case. See the next page for a list of these items.

You will need to mail or fax us copies of items that apply to your case. See the next page for a list of these items. Getting started: Health care for children CHIP and Children s Medicaid These programs offer health-care benefits for newborns and children age 18 and younger who live in Texas. With these programs, your

More information

dental plan For Students 2015-2016 Ameritas Life Insurance Corp. of New York

dental plan For Students 2015-2016 Ameritas Life Insurance Corp. of New York dental plan For Students 2015-2016 Cornell University students and dependents may enroll in an optional dental insurance plan that has been tailored to fit their needs. This plan, offered through Ameritas

More information

Windsor School Food Service

Windsor School Food Service Windsor School Food Service Date: 08/01/14 To: Parents/Guardians: From: Dana Plant, Director of Food Service RE: School Breakfast/Lunch Program Updates Dear Parents/Guardians of Children attending the

More information

Welcome To Clinica! A Guide To Services, Hours and Important Information About Clinica

Welcome To Clinica! A Guide To Services, Hours and Important Information About Clinica Welcome To Clinica! A Guide To Services, Hours and Important Information About Clinica 2013 Introduction Page 2 Important Phone Numbers Medical Appointments...303.650.4460 Billing Questions...720.206.0425

More information

Are You Eligible for Health Insurance? A GUIDE FOR IMMIGRANTS AND REFUGEES

Are You Eligible for Health Insurance? A GUIDE FOR IMMIGRANTS AND REFUGEES Are You Eligible for Health Insurance? A GUIDE FOR IMMIGRANTS AND REFUGEES It s easy to get started. Under the federal Affordable Care Act, more people are getting free or low-cost health insurance than

More information

2014-15 EMPLOYEE BENEFITS GUIDE

2014-15 EMPLOYEE BENEFITS GUIDE 2014-15 EMPLOYEE BENEFITS GUIDE ELIGIBILITY All People 2.0 employees are eligible to enroll in The American Worker program within 30 days of your first pay check. People 2.0 offers a variety of affordable

More information

A Dental plan for better health. DentalOne. Regence BlueShield. is an Independent Licensee of the Blue Cross and Blue Shield Association

A Dental plan for better health. DentalOne. Regence BlueShield. is an Independent Licensee of the Blue Cross and Blue Shield Association DentalOne A Dental plan for better health Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association Good health isn t complete without good dental care. That s where DentalOne

More information

Delta Dental of Illinois Individual and Family Insurance

Delta Dental of Illinois Individual and Family Insurance Delta Dental of Illinois Individual and Family Insurance Our dental insurance offers individuals, couples and families without an employer-sponsored dental plan access to affordable care. Smart Options

More information

St. Mary s College. of California. Student health plan handbook. Janis E. Carter, Health Net Supporting our members behavioral health needs.

St. Mary s College. of California. Student health plan handbook. Janis E. Carter, Health Net Supporting our members behavioral health needs. Commercial St. Mary s College of California Student health plan handbook Janis E. Carter, Supporting our members behavioral health needs. Jesus Hao, Ensuring your plan information is up to date. Welcome

More information

SUMMER COACH APPLICATIONS DUE APRIL 30

SUMMER COACH APPLICATIONS DUE APRIL 30 Summer 2015 Hi Reading Coach! The Team Read Summer Program is an excellent way for current and former Team Read tutors to stay involved with not only Team Read, but also the Seattle Public Library and

More information

Clifford A. Selsky, PhD, M.D. Fouad Hajjar, M.D. Ada de la Osa, ARNP-BC Shari Feinberg, CPON, CPOP Kourtnie Ramirez, MSN, CPNP

Clifford A. Selsky, PhD, M.D. Fouad Hajjar, M.D. Ada de la Osa, ARNP-BC Shari Feinberg, CPON, CPOP Kourtnie Ramirez, MSN, CPNP Clifford A. Selsky, PhD, M.D. Fouad Hajjar, M.D. Ada de la Osa, ARNP-BC Shari Feinberg, CPON, CPOP Kourtnie Ramirez, MSN, CPNP 2501 N. Orange Ave. Suite 589 Orlando, Florida 32804-3520 Phone: 407-303-2080

More information

Health Insurance Premium Assistance Program

Health Insurance Premium Assistance Program Health Insurance Premium Assistance Program PHONE NUMBERS RIte Share Tel. (401) 462-0311 Fax. (401) 462-6337 DHS Info Line (401) 462-5300 UnitedHealthcare Dental RIte Smiles (866) 375-3257 SSI (Supplemental

More information

PATIENT REGISTRATION FORM West Salem Clinic West Salem Clinic Dental Total Health Community Clinic

PATIENT REGISTRATION FORM West Salem Clinic West Salem Clinic Dental Total Health Community Clinic PATIENT REGISTRATION FORM West Salem Clinic West Salem Clinic Dental Total Health Community Clinic PATIENT INFORMATION: Last Name First Name MI : of Birth Acct. No. Marital Status Chart No. Male/Female

More information

A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. Health Insurance

A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. Health Insurance A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE The of Health Insurance THE ABC S OF HEALTH INSURANCE: WHY IS HEALTH INSURANCE IMPORTANT? Even if you are in GOOD HEALTH, you will need to

More information

P E N N S Y L V A N I A

P E N N S Y L V A N I A P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles If you have a disability and need this form in large print or another format, please call our helpline

More information

OFFICE POLICIES AND SERVICE AGREEMENT

OFFICE POLICIES AND SERVICE AGREEMENT Thomas Cicciarelli, Psy.D. PSY17298 350 Parnassus Avenue, Suite 601. San Francisco, CA 94117. 415-767-5199 OFFICE POLICIES AND SERVICE AGREEMENT Introduction Welcome to my practice. This document contains

More information

Dental / Oral Health Resources and Partners

Dental / Oral Health Resources and Partners Dental Insurance Programs Children's Health Insurance Program (CHIP) (877) KIDS-NOW The Children's Health Insurance Program, or CHIP is a state health insurance plan for children. Depending on income and

More information

Application for Employment Related Day Care (ERDC) Program

Application for Employment Related Day Care (ERDC) Program Application for Employment Related Day Care (ERDC) Program Please read these instructions before filling out this application. Answer all questions. Do not write in the shaded areas. To contact our office

More information

can provide you with medical insurance for your entire family

can provide you with medical insurance for your entire family Affordable health coverage. Quality care. can provide you with medical insurance for your entire family You may be able to receive NJ FamilyCare, free or low-cost health insurance for adults and children

More information

How to Apply To complete your application, here s what you need to do:

How to Apply To complete your application, here s what you need to do: What is Kern Medical Center Health Plan (KMCHP)? KMCHP is a county and federally-funded program that provides medical care to some people living in Kern County. It s a new way for Kern residents who meet

More information

Delta Dental of Wisconsin 2015 Open Enrollment Materials. For AFSCME Council 24, Wisconsin State Employees Union

Delta Dental of Wisconsin 2015 Open Enrollment Materials. For AFSCME Council 24, Wisconsin State Employees Union Delta Dental of Wisconsin 2015 Open Enrollment Materials For AFSCME Council 24, It s open enrollment time. Follow the steps to edit your current coverage or enroll in the plan. If you are currently enrolled

More information

MILFORD EXEMPTED VILLAGE SCHOOL DISTRICT Nutrition Services 777 Garfield Avenue Milford, OH 45150 (513) 831-5030

MILFORD EXEMPTED VILLAGE SCHOOL DISTRICT Nutrition Services 777 Garfield Avenue Milford, OH 45150 (513) 831-5030 MILFORD EXEMPTED VILLAGE SCHOOL DISTRICT Nutrition Services 777 Garfield Avenue Milford, OH 45150 (513) 831-5030 **NOW AVAILABLE** ONLINE FREE AND REDUCED APPLICATIONS FOR MILFORD EXEMPTED VILLAGE SCHOOLS

More information

Medicaid and State Health Insurance Coverage: Oral Health Care for Individuals with Disabilities

Medicaid and State Health Insurance Coverage: Oral Health Care for Individuals with Disabilities The New York State Developmental Disabilities Planning Council (NYSDDPC) distributes this information in good faith that it is accurate and current. It should not be considered complete or exhaustive,

More information

Iowa Department of Human Services

Iowa Department of Human Services What Are My Rights? You have the right to: Iowa Department of Human Services Apply for any program. File an application in person, by telephone, on line, by fax or mail at any local DHS office. Have someone

More information

Excellus How to make an HSA/FSA work for you. a Health Savings Account

Excellus How to make an HSA/FSA work for you. a Health Savings Account Excellus How to make an HSA/FSA work for you. a Health Savings Account Agenda What is an HSA/FSA? How Do They Work? How Can You Maximize Your Dollars? WHAT IS AN HSA? What is an HSA? A tax-advantaged savings

More information

How to Use Your International Student Insurance Plan For the Students of. Presented by

How to Use Your International Student Insurance Plan For the Students of. Presented by How to Use Your International Student Insurance Plan For the Students of Presented by YOUR INSURANCE ID CARD Your ID cards will be sent to you after the start of Fall term (or Spring if you are newly enrolled).

More information

HSTA VB Supplemental Group Number 2602

HSTA VB Supplemental Group Number 2602 HSTA VB Supplemental Group Number 2602 Dental Plan Benefits HDS. A plan that puts a smile on your face. This brochure includes a brief description of your HDS dental benefits. All benefits are governed

More information

PATIENT REGISTRATION FORM. Demographic Information For Office Use Only

PATIENT REGISTRATION FORM. Demographic Information For Office Use Only PATIENT REGISTRATION FORM I ll review the Welcome Packet online at www.thwcinc.com OR I d like a copy of the Welcome Packet to review while waiting Section I I want Online Access to my Medical Records

More information

Federal Employee Dental and Vision Options

Federal Employee Dental and Vision Options Federal Employee Dental and Vision Options 2016 Guide for Presbyterian Health Plan Members For more information: 1804 Juan Tabo NE, Suite A, Albuquerque, NM 87112 888 862 8659 505 237 1501 benefitsource.org

More information

Sustainable Building Science Technology

Sustainable Building Science Technology Sustainable Building Science Technology Bachelor of Applied Science Program APPLICATION FOR ADMISSION FALL 2016 1 st Review Due Date: May 13, 2016 Applications received after the first review will be accepted

More information

LEGAL AND IMMIGRATION SERVICES

LEGAL AND IMMIGRATION SERVICES LEGAL AND IMMIGRATION SERVICES ALLIANCE FOR CHILDREN S RIGHTS www.kids-alliance.org 3333 Wilshire Blvd., #550, Los Angeles, CA 90010 PH: (213) 368-6010 Legal services for LA County children from low-income

More information

Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925

Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925 Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925 Dear Parent/Guardian: Children need healthy meals to learn. TCTC offers healthy meals every school

More information

Choptank Community Health System Caroline County School Based Dental Program Healthy Children Are Better Learners DENTAL

Choptank Community Health System Caroline County School Based Dental Program Healthy Children Are Better Learners DENTAL Caroline County School Based Dental Program Healthy Children Are Better Learners DENTAL Dear Parent/Guardian: As a student in the Caroline County Public School system, your child has access to the School-Based

More information

What to Expect: Your Guide to Affordable Housing

What to Expect: Your Guide to Affordable Housing What to Expect: Your Guide to Affordable Housing NYC Housing Connect: Steps to Apply [FRONT] What does it mean for housing to be affordable? A common rule is that housing is considered affordable when

More information

Class schedules are published for Fall, Spring, and Summer. Please email ce@southark.edu to request a class schedule.

Class schedules are published for Fall, Spring, and Summer. Please email ce@southark.edu to request a class schedule. C-STOP CLASS SCHEDULE The C-Stop program was created to address the need for uniform and consistent training of contract workers in the petrochemical and energy plant environment of South Arkansas at an

More information

Healthy Kids Annual Renewal Application

Healthy Kids Annual Renewal Application Healthy Kids Annual Renewal Application Application Due By: It is time to renew your Healthy Kids health care coverage. If you would like it in another language, please call (415) 777-9992. It is time

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions What is Covered California? What is Obamacare? Are they the same? What is the Medi-Cal program? Who can buy health insurance through Covered California? When will I be able to

More information

Long Term Care Program Medical Assistance Application

Long Term Care Program Medical Assistance Application Long Term Care Program Medical Assistance Application Instructions: This is an application for Medical Assistance that will cover some or all of the costs of persons who stay in approved Long Term Care

More information

Best Practices: Ongoing Challenges. Dr. Mary Lashley Towson University October 2011

Best Practices: Ongoing Challenges. Dr. Mary Lashley Towson University October 2011 Best Practices: Ongoing Challenges Dr. Mary Lashley Towson University October 2011 Impaired nutrition and physical development Pain Absenteeism (work, school) Diabetes, CVD, Stroke Pre-term birth Self

More information

Member Rights, Complaints and Appeals/Grievances 5.0

Member Rights, Complaints and Appeals/Grievances 5.0 Member Rights, Complaints and Appeals/Grievances 5.0 5.1 Referring Members for Assistance The Member Services Department has representatives to assist with calls for: General verification of member eligibility

More information

Other Forms from Seattle Public School District

Other Forms from Seattle Public School District SEATTLE PUBLIC SCHOOLS Other Forms from Seattle Public School District Medical & Other Forms Privacy Rights Student Survey Form to Identify Disabled Students (504-2) Authorization for Medications to be

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

The policy of Island Hospital is to provide charity care consistent with the requirements of the Washington Administrative Code (WAC) Chapter 246-453.

The policy of Island Hospital is to provide charity care consistent with the requirements of the Washington Administrative Code (WAC) Chapter 246-453. POLICY STATEMENT CHARITY CARE Island Hospital Admin Page 1 of 6 The policy of Island Hospital is to provide charity care consistent with the requirements of the Washington Administrative Code (WAC) Chapter

More information

KIDCARE MEMBER HANDBOOK

KIDCARE MEMBER HANDBOOK KIDCARE MEMBER HANDBOOK KC 3793 (N-3-02) THIS HANDBOOK IS ONLY FOR CHILDREN AND PREGNANT WOMEN. IF YOU ARE AN ADULT AND NOT PREGNANT, YOU SHOULD CALL YOUR ILLINOIS DEPARTMENT OF HUMAN SERVICES (DHS) LOCAL

More information

Let us help you choose the health insurance plan that fits your needs

Let us help you choose the health insurance plan that fits your needs Let us help you choose the health insurance plan that fits your needs Call 866-445-1396, visit bcbsnm.com or contact an independent Blue Cross and Blue Shield of New Mexico broker to get a quote today.

More information

Greetings and Information

Greetings and Information ISSO CONTACT INFORMATION International Students and Scholars Office (ISSO) 524 Riverside Drive in International House North between 122 nd St. and Tiemann Place http://www.columbia.edu/cu/isso/incoming/isso_location.pdf

More information

How To Get Health Insurance At Columbia

How To Get Health Insurance At Columbia Columbia Health 2012-2013 1 Table of Contents Premiums and Fees 3 Columbia Health Program 4 Columbia Student Medical Insurance Plan 5 Enrollment in the Columbia Plan 7 Additional Options 9 Waiver from

More information

Get Care. Get Covered.

Get Care. Get Covered. Get Care. Get Covered. Family Planning Benefit Program & More FPBP Contents What is the Family Planning Benefit Program?... What are the benefits?... Who is eligible?... How do I apply for FPBP?... Where

More information

Health Insurance A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. HL-14-001 Rev. 08/2015

Health Insurance A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. HL-14-001 Rev. 08/2015 A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE The of Health Insurance wahealthplanfinder.org 1-855-WAFINDER 1-855-923-4633 HL-14-001 Rev. 08/2015 THE ABC S OF HEALTH INSURANCE: WHY IS HEALTH

More information

South Dakota Application for Medicare Savings Program

South Dakota Application for Medicare Savings Program DSS-EA-270 10/15 South Dakota Application for Medicare Savings Program NOTE: This application CAN be used for a single person or a couple (self and spouse). If you want more information on the following

More information

You should see the following screen when you first login to Student E-Service

You should see the following screen when you first login to Student E-Service You should see the following screen when you first login to Student E-Service Check your status at the bottom of the screen. It should read Ready to Register Online You will find useful information in

More information

Table of contents. Guide for incoming students SRI Université de Cergy Pontoise October 2013 1

Table of contents. Guide for incoming students SRI Université de Cergy Pontoise October 2013 1 Table of contents THINGS TO TAKE CARE OF PRIOR TO YOUR ARRIVAL... 2 1. In order to fulfill the administrative portion of your administrative enrolment, please prepare the following documents in due time:...

More information

Medicaid Presumptive Eligibility Instructions for Providers September 2015

Medicaid Presumptive Eligibility Instructions for Providers September 2015 Medicaid Presumptive Eligibility Instructions for Providers September 2015 KC 3767 (R-7-15) 0 MEDICAID PRESUMPTIVE ELIGIBILITY PROGRAM OVERVIEW The Medicaid Presumptive Eligibility (MPE) program is one

More information

CHILD CARE GRANT SPRING 2016, SUMMER 2016

CHILD CARE GRANT SPRING 2016, SUMMER 2016 1130 Women s Resource /Returning Adult Program Lansing Community College P. O. Box 40010 Lansing, Michigan 48901 7210 Phone: (517) 483 1199 Fax: (517) 483 9645 http://www.lcc.edu/wrc email: wmnrsrc@lcc.edu

More information

Dental Plus of Oregon. You re telling me my teeth can really last a lifetime? THE POLICY PROVIDES DENTAL BENEFITS ONLY.

Dental Plus of Oregon. You re telling me my teeth can really last a lifetime? THE POLICY PROVIDES DENTAL BENEFITS ONLY. You re telling me my teeth can really last a lifetime? Dental Plus of Oregon THE POLICY PROVIDES DENTAL BENEITS ONLY. orm No. 2121D-OR(12/15) Agreement orm No. 2121-OR(7/12) This discount dental plan is

More information

TRANSPORTATION SERVICE STANDARDS 2015-2016

TRANSPORTATION SERVICE STANDARDS 2015-2016 TRANSPORTATION SERVICE STANDARDS 2015-2016 Effective 9/1/2015 The superintendent is authorized to make minor modifications to the District Transportation Standards and/or operational procedures as required

More information

2015-2016 MIT affiliate Health Plan

2015-2016 MIT affiliate Health Plan 2015-2016 MIT affiliate Health Plan - Top five things you need to know - Insurance plan rates - Your medical benefits - How to enroll - Commonly used terms - Useful contact information The top five things

More information

How To Help Older Adults In Wisconsin

How To Help Older Adults In Wisconsin 1 The is a Department of St. Croix County Health & Human Services Website: www.sccwi.us/adrc 2 MISSION STATEMENT The purpose of the Aging & Disability Resource Center is to empower & support older adults,

More information

Dental. Call 311 or one of our clinics (See list on the back of this form) to check eligibility and or to make an appointment for treatment.

Dental. Call 311 or one of our clinics (See list on the back of this form) to check eligibility and or to make an appointment for treatment. Dental Background Many newcomer families may not be able to afford the cost of dental services. Toronto Public Health Dental and Oral Health services provide free dental treatment and prevention services

More information

Flyer Internet Source (Please circle one): Office Webpage Google Facebook Other Insurance Please Specify. Last Name First Name M.I.

Flyer Internet Source (Please circle one): Office Webpage Google Facebook Other Insurance Please Specify. Last Name First Name M.I. Welcome and Thank you for choosing us as your oral care provider! To help us meet all your dental needs, please fill out this form completely. If you have any questions or need assistance, please ask us

More information