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Get SC ADAP INSURANCE APPLICATION - Dhec Sc

SC ADAP INSURANCE ASSISTANCE APPLICATION FOR ADAP USE ONLY - DO NOT WRITE IN THIS SPACE Date Received Status/Date Final Status/Date Completed By Return to Insurance Assistance Program IAP 3rd Floor Mills Jarrett Box 101106 Columbia SC 29211 PH 803 898-0829 or 877 606-8498 FAX 803 898-7683 Instructions This form is for applicants applying for assistance with private/commercial insurance coverage. CLINICAL INFORMATION To be completed by the Physici.

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