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Eligibility

Florida Department of Health in Walton County

Eligibility Form
Eligibility Form Spanish
Initiation of Services
Initiation of Services-Spanish
No Show Policy-English
No Show Policy-Spanish
Patient Information-English
Patient Information-Spanish
Personal Contact-English
Personal Contact-Spanish
Notice of Privacy Practices
Notice of Privacy Practices-Spanish

Good Faith Estimate

Advance Directives Information

 


DOCUMENTS REQUIRED FOR ELIGIBILITY DETERMINATION 

In order to receive certain services at Florida Department of Health  - Walton or Walton Community Health Center you must be financially screened.

You may elect to pay full fee instead of going through our eligibility screening process

Please bring the following items with you:

  • Identification Card (picture ID preferred), other examples are voter registration card, birth certificate, infant hospital records, paycheck stub, passport, etc.
  • Proof of residency(utility bill – electric or phone bill, bank statement, school record, recent driver’s license, foster child placement letter/notice, housing rent/mortgage agreement, US Military orders, paycheck/stub with name and address, shelter letter signed/dated by staff, property tax receipt, W-2 form for previous year, unemployment documents in applicant’s or client’s name, voter registration card or letter from person applicant lives with and proof (such as utility bill, etc. with the name/address of individual with whom the applicant or client is living)
  • Any insurance card(s)
  • Four (4) weeks most current/consecutive pay stubs:
    • If recently terminated – final paycheck or statement on letterhead stating you are no longer employed at company
    • If unemployed – copy of unemployment income statement, food stamp statement, SSI statement, and retirement statements, etc.
    • No income – bring a letter from whoever is paying room and board with their signature, or have responsible party come in with you and sign letter documenting the amount of support you are provided