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Com/ patient/ onecard/ goldcard. Download hchd gold card application. Drop off to the nearest Eligibility Center.

False or incomplete information given on this form may result in criminal action being taken under Sections 31. Depending on your household income you could qualify for medical assistance that. If someone other than your spouse supports you, he/ she must fill out this form:.

If you are asked to pay for a Gold Card, please report this to. The Harris Health System is not free, but there is financial assistance for those who qualify. The old " Gold Card" - the yellowish ID that a patient previously presented to indicate under which charity payment plan he she qualified - is no longer the system' s passport to care. This is an Official Government Record.

1 Download an online application make copies of additional required documents , then mail them to drop them off. STATEMENT OF SUPPORT. There is No Fee for a Gold Card.

Texas residents who reside in Harris County have the option of applying for Harris Health formally known as the Gold Card which is a medical assistance program offered by the Harris County Hospital District ( HCHD). 10 other portions of the Texas Penal Code. The Harris Health System helps people with low , previously called the Gold Card no income get quality health care.

Applying for Financial Assistance: Call‐ 6509 to schedule an appointment or. If you are uninsured the Harris Health System is a way for you to find affordable sliding- scale healthcare. The old “ Gold Card” – the yellow- colored ID that a patient previously presented to indicate under which charity payment plan he she qualified – is no.

Eligibility: Harris County residents are eligible but can' t apply online so – Either: Download an online application make copies of additional. The website that you will need to download the form from which will give you any help that you need in filling is: www. HCHD Financial Assistance Program.

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Financial assistance with HCHD, you may fax, mail, or drop off your application with supporting documents at any Eligibility Center. naturalization, citizenship or other federal documents, hospital or birth records, adoption papers or records, voter' s registration card, or wage stubs.
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The Harris Health System, previously the Harris County Hospital District ( HCHD), is a governmental entity with taxing authority that owns and operates three hospitals and numerous clinics throughout Harris County, Texas, United States, including the city of Houston. The entity' s administrative offices are in Houston. There is no cost to make a Harris Health Financial Assistance Application.

Other federal document showing your name and address in Harris County. • Social Security card.

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• Medicaid card. • Medicare card.

• Current IRS 1040/ 1040A tax return ( all.
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To download and print the TX Medicaid / CHIP application, please go. Although you can download the application form that you need to complete, it is not possible to apply online for a Harris County Hospital gold card.
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