Thank you for choosing Texas Native Health! The items listed below must be uploaded here in order to schedule a new patient appointment:
1. Eligibility Documents:
- CDIB (Certificate Degree of Indian Blood) card issued by the Bureau of Indian Affairs, or
- Federally recognized tribal enrollment card, or
- Letter of Descendancy; or
- Legal documentation proving descendancy in the first or second degree from a person possessing a Certificate of Degree of Indian Blood (CDIB) Card or Tribal Enrollment Document (documentation must be approved by TNH staff)
2. Social Security Card: All persons must have a Social Security card within one year from the date of birth.
3. Photo Identification:
- Current driver’s license or State issued ID, or
- 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 ID can be obtained, but cannot be used for obtaining prescriptions for controlled substances.
4. Certified Birth Certificate: Required for all applicants under 18 years of age. Appointed guardians must have court documentation for minor children.
5. Immunization Record: For persons under 16 years of age.
6. Medication List: Needed for all applicants. Please provide a list of any prescriptions and over-the-counter medication you are taking (Including herbal/supplements, and vitamins/minerals).
7. Medicaid, Medicare, private or tribal insurance card: If you are receiving Medicaid, Medicare or if you have private or 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 (marriage license, divorce decree, court papers, etc.)
RIGHT TO REFUSE SERVICES
Texas Native Health reserves the right to refuse services to anyone for cause which includes but is not limited to: belligerent or abusive behavior; failure to comply with all third party payor processes (Indian Health Services is considered the payer of last resort); non-compliance with treatment; or any other violation of the Patient’s Rights and Responsibilities.
Texas Native Health reserves the right to make the final determination of eligibility.
Please call the Registration Desk for any issues or concerns at (214) 941-1050.