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Get DSH-001 2015-2024

Arket d, Mutual Fund e. Stocks f, Bonds g. Other * Total Health Bills Owed: *Total Resources: *Countable Resources shall be reduced by unpaid medical expenses of the family unit to establish eligibility. 20. Other Information: a. Was date of service related to an auto accident? Yes No b. Have you applied for and been denied Medicaid or KCHIP Benefits? Yes No Section 2: Hospital Indigent Care Criteria 1. An individual must meet all of the following conditions: a. The individual is a resident o.

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