Basic Legal Requirements
- Must be 18 years old or older with proof of patient’s identity and age
- Must be a resident of Illinois with proof of residency
Proof of Qualifying Conditions
- Must have one of the qualifying conditions
- Must have a written certification with a bona fide physician-patient relationship
Complete the Paperwork
- Notarized Homeless Status Certification for homeless qualifying patients
- Payment of application fee by check or money order
- Copy of DD214 for Veterans
- Letter or other documentation as proof of patient’s SSDI or SSI disability program participation showing the amount of monthly disability benefits to be received
- Applications may be completed online or sent via U.S. mail