Eligibility

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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 2017 Federal Poverty Guidelines.

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