What telephone # and time of day best to contact:
1. Does the patient have insurance?
2. Has the FAP applications been secured?
MEDICAID FOR WOMEN, CHILDREN AND FAMILY PROGRAMS – If yes to any question, refer immediately.
1. Is the patient under the age of 18?
2. Is the patient between ages 18 and under 21?
3. Is the patient pregnant?
4. Does the patient have any biological or adoptive children in household under 18 years of age?
MEDICAID FOR THE AGED, BLIND, & DISABLED – If yes to any question, refer immediately.
1. Is the patient currently receiving SSI or SSD?
2. Does the patient have any of the following conditions:
- Total Deafness
- Total Blindness
- Confinement to bed or wheelchair due to condition.
- A stroke occurring three months ago, resulting in inability to walk independently.
- Amputation of leg at hip
- Cerebral Palsy, Muscular Dystrophy, or Muscular Atrophy, Down Syndrome
- Requires hospice care for cancer
- Severe prematurity
- Spinal Injury resulting in the inability to walk
3. Is the patient 65 or older and not on Medicare?
4. Have you been deemed Disabled by a Physician for at least a year?