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 serve all community members and offer services on a sliding fee schedule, based on income. SEARHC’s facilities are FTCA deemed by the Federal Government.

 

If you live in one of the following clinic communities, please use these forms to enroll in the sliding fee discount program:

  • Klukwan
  • Haines
  • Kake
  • Angoon
  • Hoonah
  • Pelican
  • Tenakee
  • Klawock
  • Hydaburg
  • Thorne Bay
  • Kasaan

 

If you live in one of the following clinic communities, please use these forms to enroll in the sliding fee discount program:

  • Wrangell
  • Gustavus
  • Excursion Inlet
  • Coffman Cove
  • Whale Pass
  • Naukiti
  • Edna Bay
  • Point Baker
  • Port Protection
HRSA-2017-application AICS (PDF 94kb)
  • Juneau (Front Street Clinic)
HRSA-2017-application_FSC (PDF 73kb)

 

Each health center above receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

 

PDF files require Acrobat Reader