What to Bring:
- Completed forms (see below)
- State Authorized Photo ID (such as a driver's license)
- Social Security Card
- Insurance Provider Card
- A list (or the bottles) of all your prescriptions
PATCH Center Printable Forms:
Discount Fee Schedule:Clarity Healthcare's sliding fee discount schedule is based on the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C 9902(2), with approval from Clarity Healthcare's Board of Directors.
In order to qualify for the sliding fee program, patients must complete the sliding fee program application paperwork and provide the appropriate proof of income. Patients cannot be seen on the sliding fee program until they have completed their sliding fee paperwork and have been enrolled by Clarity Healthcare staff. Enrollment must be renewed annually.
You will need to verify your household income at the time of application. The following are approved ways to verify your household income:
- Unemployment Compensation
- Workmen's Compensation
- Welfare Benefits
- Social Security
- Supplemental Security Income
- Veteran's Benefits
- Survivor's Benefits
- Earnings from need-based Employment programs
- Regular Contributions from persons not living in household
- *Any other income not included in the list above.
Important information to bring with you:
- Proof of income includes all persons living in the household.
- Any household member determined to potentially qualify for Medicaid coverage is required to apply for Medicaid.
- If the necessary paperwork is not provided, the appointment can either be rescheduled or full fee charges will apply.
- The following documentation is required at the time of appointment:
- Proof of Income
- Photo ID
- Click here for Additional Proof of Income Information
Transportation and Translation Assistance:
Translation services are available for those who are hearing impaired or have limited English proficiency.