Eligibility
Eligibility Policy & Procedure
Attachments
What to Bring List for Patients (English, pg. 1; Spanish, pg. 2)
Eligibility Procedure Guides
Eligibility Matrix
Calculating Federal Poverty Level (FPL)
Determining Sliding Fee Scale (SFS)
Assigning Payor Source Guides
Males & Patients Under 18
Adult Female - New Patient
Adult Female - Established Patient
HealthPoint Registration Packets
HealthPoint Registration Packet- English
HealthPoint Registration Packet- Spanish
DSHS Eligibility Packets (Individual & Family)
Individual DSHS Eligibility Packet- English
Individual DSHS Eligibility Packet- Spanish
Household DSHS Eligibility Packet - English
Household DSHS Eligibility Packet - Spanish
DSHS Additional Forms
Employment Verification (Form 128)
Statement of Self-Employment Income (Form 149)
Household Eligibility Worksheet (EFO5-13227)
Texas Women's Health Program (TWHP)
TWHP Application
TWHP Screening Tool (Spanish)