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Federal and state guidelines require all patients
who seek services at the Austin Health Center to provide appropriate
medical history and personal information. Following is a list of
items required to document your identity, income, proof of dependents
and proof of or lack of insurance coverage.
 Identification:
A photo ID, valid drivers license, social security card, or birth
certificate.
Proof of Income: A copy of last
years tax return, a current pay check stub, unemployment check
stub, pension check stub, child support payment documentation
or foster care allotment check.
Proof of Dependents: A copy of
last year’s tax return or birth certificates.
Proof of Medical / Dental Coverage:
A current Medicaid or Medicare card, managed care company insurance
card indicating Austin as your primary medical or dental provider,
copy of other insurance card indicating type of coverage.
Proof of “No” Income: Employment
termination papers, denial of public assistance, family support
verification, or other written letter or verification. Forms are
available at the heath center’s front desk.
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