HRSA Community Health Center Forms
Some SEARHC facilities are classified as Community Health Centers and receive funding from the U.S. Health Resource and Services Administration (HRSA) for providing health services in underserved areas. As Community Health Centers, these clinics can treat non-Native patients using a sliding fee schedule based on income. SEARHC’s facilities are FTCA deemed by the Federal Government.
The SEARHC clinics that qualify as Community Health Centers are the Jessie Norma Jim Health Center in Angoon, the Haines Health Center, the Hoonah Health Center, the Alma Cook Health Center in Hydaburg, the Kake Health Center, the Kasaan Health Center, the Alicia Roberts Medical Center in Klawock, the Klukwan Health Center, the Pelican Health Center, the Genevieve Soboleff Health Center in Tenakee Springs, and the Thorne Bay Health Center.
The forms linked below are for use in the above clinics (additional clinic information can be found by clicking the links in the right column).
- 2017 HRSA Application (PDF 103kb)
- HRSA Income Verification form 03-17-2016 (PDF 20kb)
- Signature Verification and Q & A form 03-17-2016 (PDF 97kb)
PDF files require Acrobat Reader