Family Information and Income
List all family members in your household and their date of birth.
Please provide the following information for all of the people in your immediate family who live in your home. For purposes of HCAP, family is defined as the patient, the patient’s spouse, and all of the patient’s children under 18 (natural or adoptive) who live in the patient’s home. If the patient is under the age of 18, the family shall include the patient, the patient’s natural or adoptive parent(s), and the parent(s) children under 18 (natural or adoptive) who live in the patient’s home.