J.C. Lewis Primary Health Care Center, Inc.

Patients

Eligibility Requirements

Services are based on a sliding fee scale.

Cost of Services/Eligibility:

Services are provided at an affordable rate to qualifying uninsured, under insured, and homeless persons with limited income. Picture ID , proof of income and  verification forms, (homeless) are required at the time of service to determine eligibility.

Eligibility is based on household income and patients must bring ONE of the following to the center to determine if they are eligible for sliding fee discount:

  • Current year’s tax form (1040 form)
  • 2 current pay stubs
  • 2 unemployment stub
  • Notarized letter from employer on letterhead that states your salary or wages
  • Fixed income statement (example: pension, social security or bank statement showing deposits)
  • Signed and notarized personal letter verifying financial status, housing situation and how you cover expenses
  • Letter on agency letterhead verifying financial status (example: Housing Authority)
  • Office of Public Assistance benefit printout (example: TANF, Emergency Financial Assistance)
  • WG15 (Georgia Department of Labor)
  • If you are self employed – tax forms from current year and a profit and loss statement

We accept Medicaid, Peach Care, Well Care, AmeriGroup, Cash and Credit Cards.  No personal checks.

Patients Forms: