Clinic Eligibility
Clinic Eligibility
Eligibility requirements vary depending on the service provided. Some services are free, some are a flat fee and others have a fee based on a sliding scale. Sliding scale means that in general, the more income you have, the larger the fee you pay for services. Financial eligibility is determined annually and whenever there is a change in financial status. You must have identification and proof of income when services are provided. Click below to view what documents are acceptable for proof of identification and income.
Proof of Identification
Infant/Child:
- Birth Certificate
- Passport/Visa
- Medical/hospital record
- Hospital/clinic record
- Social Security card
- AFDC/Welfare Photo ID
- Proof that mother is on WIC (WIC ID Folder)
Adults:
- Birth Certificate
- Driver's License
- Passport/Visa
- Immigration or Naturalization Record
- Marriage certificate/license
- Medical/Hospital record or chart
- Hospital/clinic ID card
- School records
- Military records/Military ID/Military Discharge papers
- Social Security card
- AFDC/Welfare photo ID or copy of letter from Social Services stating amount of AFDC payments
- Valid Medicaid Card
Proof of Income includes but not limited to the following:
- Pay Stubs - provide either the most recent with "Year to date" income listed
- W-2 Form or income tax return for most current calendar year
- Unemployment notice from VEC (Virginia Employment Commission)
- Statement of Social Security benefits or other benefits
- Military LES (leave and earning statement) (WIC Program Only)
- Foster care statement from Social Services
- Food stamps - Letter of eligibility (WIC Program Only)
- AFDC check stub (WIC Program Only)
- Medicaid card for current month
- Free or reduced school lunch - letter of eligibility (WIC and Dental (for free) Programs Only)
Clinic Fees
Flat Fee Services:
- Tuberculin testing for adults
- Routine Adult Immunizations - based on cost of vaccine plus administrative fees
- Call for further information
Free Services:
- Investigation of Communicable Diseases
- Identification and testing of contacts of Tuberculosis cases
- Required Childhood Immunizations (birth up to nineteenth birthday.)
Sliding Scale Services:
- Family Planning Services
- Maternity Services
- Pediatric Services
- Treatment of Tuberculosis
- Dental Services (free to children in school lunch program)
Sliding Scale Guidelines:
Based on client income, payment will be full fee, 95% (of full fee), 75%, 50%, 25%, 10% or free.
| Family Size | Free if less than: | Full Fee if above: |
| 1 | $12,880 | $32,201 |
| 2 | $17,420 | $43,551 |
| 3 | $21,960 | $54,901 |
| 4 | $26500 | $66,251 |
| 5 | $31,040 | $77,601 |
| 6 | $35,580 | $88,951 |
| 7 | $40,120 | $100,301 |
| 8 | $44,660 | $111,651 |
| 9 | $49,200 | $123,001 |
| 10 | $53,740 | $134,351 |