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Get CO Proof of Identity and Residency Waiver 2016-2024

Photo ID with their application. Out of state ID’s WILL NOT be accepted upon renewal. Minor patients: Identity and residency documents must be in the primary parent’s full name. STAFF ONLY Patient Information 1. Last Name 2. First Name 3. Middle Initial 4. Date of Birth ________ Evaluated 5a.Submit two (2) of the following: Both must include your full name. Out-of-state driver's license or photo ID (must not be expired) Military ID (copies of both front and back, along with a copy of M.

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