Copyright © 2020 Universal Community Health Center (UCHC). All rights reserved. 
Our mission: Provide quality and accessible healthcare to underserved communities. UCHC is a 501(c)(3) organization.

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Enrollment Documents

Click to see documents required for enrollment

For Medi-Cal, bring these documents:

 

  • Picture identification (eg California ID, Passport, Consular ID, School ID, Driver’s license)
     

  • Proof of Address (Mail no older than 60 days) (eg ID with correct address, utility bill addressed to applicant/parent, letter addressed to applicant)
     

  • Proof of Income (Pay stubs no older than 45 - 60 days) (eg recent Income Taxes, three most recent pay stubs, written self-affidavit of income)
     

  • Social Security Number (eg Social Security Card, recent Income Taxes)
     

  • Proof of Citizenship (Foreign-born citizens) (eg Certificate of Naturalization/Citizenship, Permanent Resident Card, Work Permit.

For Medicare, bring these documents:

 

  • Picture identification (eg California ID, Passport, Consular ID, School ID, Driver’s license)
     

  • Proof of Address (Mail no older than 60 days) (eg ID with correct address, utility bill addressed to applicant/parent, letter addressed to applicant)
     

  • Proof of Income (Pay stubs no older than 45 - 60 days) (eg recent Income Taxes, three most recent pay stubs, written self-affidavit of income)
     

  • Social Security Number (eg Social Security Card, recent Income Taxes)
     

  • Proof of Citizenship (Foreign-born citizens) (eg Certificate of Naturalization/Citizenship, Permanent Resident Card, Work Permit.

For My Health LA, bring these documents:

 

  • Picture identification (eg California ID, Passport, Consular ID, School ID, Driver’s license)
     

  • Proof of Address (Mail no older than 60 days) (eg ID with correct address, utility bill addressed to applicant/parent, letter addressed to applicant)
     

  • Proof of Income (Pay stubs no older than 45 - 60 days) (eg 2017 Income Taxes, three most recent pay stubs, written self-affidavit of income)
     

  • Social Security Number (eg Social Security Card, recent Income Taxes)
     

  • Proof of Citizenship (Foreign-born citizens) (eg Certificate of Naturalization/Citizenship, Permanent Resident Card, Work Permit.

For Covered California, bring:

 

  • Picture identification (eg California ID, Passport, Consular ID, School ID, Driver’s license)
     

  • Proof of Address (Mail no older than 60 days) (eg ID with correct address, utility bill addressed to applicant/parent, letter addressed to applicant)
     

  • Proof of Income (Pay stubs no older than 45 - 60 days) (eg 2017 Income Taxes, three most recent pay stubs, written self-affidavit of income)
     

  • Social Security Number (eg Social Security Card, recent Income Taxes)
     

  • Proof of Citizenship (Foreign-born citizens) (eg Certificate of Naturalization/Citizenship, Permanent Resident Card, Work Permit.

For Private Health Plans, bring:

 

  • Picture identification (eg California ID, Passport, Consular ID, School ID, Driver’s license)
     

  • Proof of Address (Mail no older than 60 days) (eg ID with correct address, utility bill addressed to applicant/parent, letter addressed to applicant)
     

  • Proof of Income (Pay stubs no older than 45 - 60 days) (eg 2017 Income Taxes, three most recent pay stubs, written self-affidavit of income)
     

  • Social Security Number (eg Social Security Card, recent Income Taxes)
     

  • Proof of Citizenship (Foreign-born citizens) (eg Certificate of Naturalization/Citizenship, Permanent Resident Card, Work Permit.