How to Become a Patient 

 

SCREENING DAYS: MONDAYs and WEDNESDAYs. Doors open at 7:00am. First 12 who sign-in will be seen for a financial screening. Line-up around 5:30am or 6:00am.

How to Receive Care: Medical care is provided free of charge for patients between the ages of 19 and 64 without health insurance and with income up to 200% of the Federal Poverty Level. Clients must first go through financial screening process to verify eligibility.

Requirements:

  • Must be a resident of Montgomery, Autauga, or Elmore Counties

  • Must be between the ages of 19 and 64.

  • Must have a Social Security number and proof of that number

  •  Must NOT have Medicare, Medicaid, VA medical benefits, or private insurance.

Items needed for financial screening (not all will apply to you):

  • Picture ID (must be current)

  • Social Security Card (OK if on driver’s license, income tax filing, W2Proof of Current address (current within 90 days)

  • Pay Stubs (at least 3, current within 90 days

  • Proof of Social Security Benefits (yearly letter from Social Security Office)

  • Current Medicaid denial letter (Please go to Montgomery Health Department Medicaid office)

  • Proof of unemployment compensation

  • Proof of unemployment compensation

  • Proof of Alimony Benefits

  • Proof of Child Support

  • Home Appraisal value (printout from Property Tax is acceptable)

  • Checking and Savings Bank Statement

  • IRA (copy of certificate)

  • House or Utility Allowance (letter from Housing Authority showing amount)

  • Food stamp Assistance letter with a dollar amount listed (we can not accept the Interview Summary)

  • Federal 1040, W2, 1099 

AFTER SCREENING: Once approved, you will received a letter from Baptist Health Systems. This letter is important and must be kept in a safe place and provided at every encounter at Baptist Labs, Radiology, Emergency Room or specialist offices. If you lose this letter then you would need to contact Baptist Health Business Office at (334) 273-4270 to obtain a new one. Medical Outreach Ministries is NOT responsible for your Baptist Charity letter.

RESCREENING: You MUST be approved before the day of your next appointment or next specialist appointment in order to continue to be eligible for services at Medical Outreach Ministries. 

Click HERE to print the application and fill out before your screening if you are able.

Click HERE to print the notarized letter form. 

Click HERE to print a copy of our financial screening form (information listed above).