To register as a patient, you must submit original official documents:
- Eligibility Documents:
- CDIB (Certificate of Degree of Indian Blood) card issued by the Bureau of Indian Affairs, or
- Federally recognized tribal enrollment card, or
- Letter of Descendancy from a federally recognized tribe.
- Social Security Card: All persons must have a Social Security card within one year from date of birth.
- Photo Identification: Current driver’s license, State issued ID, passport, or government ID with picture for all persons aged 18 or older. (Tribal enrollment card with a recent photo may be used until a current State I.D. can be obtained, but cannot be used for obtaining prescriptions for controlled substances)
- Certified Birth Certificate: Required for all applicants under 18 years of age. Appointed guardians must have court documentation for minor children.
- Immunization Record: For persons under 16 years of age.
- Medication Profile: Needed for all applicants. Please provide a list of any medications (prescriptions and over-the-counter) you are currently taking.
- Medicaid, Medicare, private or tribal insurance card: If you are receiving Medicaid, Medicare or if you have private/tribal insurance please provide a copy of your card(s) to the registration staff upon each visit. The clinic is required by Federal law to seek and collect payment from any insurance the patient may be eligible to participate in and patients are required to provide this information.
If the name(s) on your CDIB, identification and social security card do not match, you must provide legal verification of name change. This includes marriage license, divorce decree, court papers, etc.
Oklahoma City Indian Clinic reserves the right to make the final determination of eligibility. Documents can be sent to firstname.lastname@example.org