CommunityHealth Patient Intake Requirements

To establish care at CommunityHealth you must follow these general requirements:

• Be uninsured, with the exception of Medicare part A (must provide card)
• Income must be below 250% of Federal Poverty Guidelines
• CommunityHealth must be your primary provider
• Not eligible for a government sponsored program

A potential patient must come to CommunityHealth and complete an Intake Form.

Intake/Registration Hours

Please bring the following information with you at the time of intake:

• Proof of Income
  • TAX RETURNS from previous year
    AND ONLY if you did not file taxes, you may bring:
  • Check stubs for the past 30 days
  • OR written statement from employer if you get paid cash
  • OR supporter’s income, if you are supported by someone else
• Proof of address (NOTE: we do not accept PO Boxes as proof of address)
• Picture ID
• List of current medications
• Copy of all past medical records (if you have seen a physician in the last three years)
• Letter of termination from insurance company (if applicable)

For more information about becoming a CommunityHealth patient, please contact Virginia Gallegos, Intake Coordinator, at 773.395.9900 ext. 24 or at vgallegos@communityhealth.org.