Providing Free Healthcare Services In The Pee Dee Region

Picture ID with current Pee Dee County address (must match bills / sample mail address)

Social Security Card or Green Card

Current Medicaid Denial Letter dated within one year and stapled (3300 Form)

Any household bills in your name. (i.e.: lights, water, phone, cable, mortgage, lease or medical bills, etc.)

• If no bills: please provide a monthly sample of mail with your name of current address

Proof of household income (i.e.: w2, last 1040 tax form, or check stubs - last 6 weeks)

• Include the following types of income that apply to you:

  • Please provide print outs for current year:

    • Unemployment History

    • Worker's Compensation

    • Child Support or Alimony

    • Social Security/Disability Award Letter

    • Food Stamps