Eligibility

Haga clic aquí para versión en español

Caridad Center provides comprehensive health services to UNINSURED children and adults who live in Palm Beach County and are at or below the 200% federal poverty level. Applicants must first go through the Registration/Eligibility Process before making an appointment at the Clinic. To see if you qualify please check the guidelines:

200% Federal Poverty Level Guidelines 2019

Federal Poverty Level Guidelines 2019

Registration/Eligibility is available:

Mornings: Tuesday thru Friday at 8:00 a.m.

No appointment is necessary – However, the process is first come, first serve

• Only the first 25 applicants each day will be able to complete the eligibility process.
• At least two hours should be allotted for the process.
• Depending on the number of inquiries, the process could take more or less time.
• To expedite the process, please print and fill out ALL the forms listed here and bring them with you.

Patient Registration
HIPPA Authorization for Non-Routine Disclosure
HIPPA Non-Discrimination & Grievance Form
HIPPA Non-Discrimination & Grievance Form (Spanish)
Medical Patient History
Treatment Consent Form

All applicants must provide these three (3) items:

Proof of Income

Examples:

• a paycheck stub
• a letter from your employer (on business letterhead including company name, address, and phone number)
• unemployment forms
• a notarized letter from the person who is financially responsible for the household

Identification Card

Examples:

• driver’s license
• counselor card
• passport
• other recent I.D. with name and photo

Please note: Minors under the age of 18 must:

• be accompanied by a parent or legal guardian
• bring a copy of their birth certificate

Proof of Address

Examples:

• phone bill, FPL bill
• car registration or insurance
• other recent document received in the mail with your name and address