How it works…
Hoxie Medical Clinic offers a Sliding Fee Scale Discount to all eligible uninsured or under-insures patients. This program allows qualifying patients to receive medical care at a lower cost. Eligibility for the Sliding Fee Scale will be established by determining the household size and the annual household income. This info must be updated annually. HMC requires valid proof of income, household size, & completion of a Household Assessment when applying for the sliding scale fee discount.
If a patient chooses not to provide the required information, then he/she will not receive the discounted rate offered through the Sliding Fee Scale Discount Program.
If the patient declares no income, the patient must provide a collaborative letter from the individual assisting the patient financially (who is helping pay your bills, provide housing, etc).
Sponsored Care Application Process
A completed application including the required documentation must be on file and approved by the business office before a discount will be granted. Those requiring assistance with the applicaiton process may contact Peggy Ritter at 785-677-4172.Download the Sponsored Care Application
Other Downloadable Forms
Save yourself time when you come in for your appointment by filling out the appropriate forms and bringing them with you.
If you are bringing your child in for a well-child exam, please click on the following link and on the left side of the page select, “BRIGHT FUTURES TOOL and RESOURCE KIT.” Select the appropriate age tool, open and print the correct “TOOL,” fill it out and bring it to your visit. (if you get a pop-up, just “cancel”)Bright Futures Tool
What you need to bring:
NEW PATIENTS: Please fill out the following Demographic Form and bring it to your first visit. Also, ESTABLISHED PATIENTS: Please fill out the Demographic Form & bring it with you to your FIRST VISIT in a NEW YEAR. To better serve you, and to be compliant with federal regulations, we must update your information annually.
*** Must be updated annually ***
Authorization for the release of your medical records to HMC
Hoxie Medical Clinic’s Privacy Information Form
Acknowledgment of receipt of notice of Privacy Information
826 18th Street, Suite A
Hoxie, KS 67740-4373
P.O. Box 415
Hoxie, Ks. 67740
**Active Patient Portal account required.
**An email address must have been provided to us durring registration. A Patient Portal invitation would have been emailed directly to you. If you are unable to login, please contact the Hospital Business Office at 785.675.3281 for assistance.
Click HERE to enroll.
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