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Care Card and CCP Application Eligibility Prescreen Required Items Rev 12/7/2017 To book an appointment please call the Front Desk (970)6684040 Please, bring all applicable items listed below: Application

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How to fill out care card and cicp

01

To fill out a care card, follow these steps:

02

- Write your full name on the designated space

03

- Provide your personal information such as date of birth, address, and phone number

04

- Indicate your medical history, including any known allergies or chronic conditions

05

- Include emergency contact details

06

- Sign and date the card to validate the information

07

To fill out a CICP (Colorado Indigent Care Program) form, do the following:

08

- Provide your personal information including name, address, and contact details

09

- Declare your income and provide supporting documents such as pay stubs or tax returns

10

- Indicate your household size and any dependents

11

- Provide information on any insurance coverage you currently have

12

- Sign and date the form to confirm the accuracy of the provided details

Who needs care card and cicp?

01

Care card and CICP are typically required by individuals who:

02

- Are seeking healthcare services in a healthcare facility

03

- Want to access discounted or free medical care

04

- Meet the income and eligibility criteria for the CICP program

05

- Reside in the state of Colorado

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What is care card and cicp?

Care card stands for Child Abuse Reporting Evaluation. CICP stands for Child Injury Compensation Program.

Who is required to file care card and cicp?

Certain professionals such as doctors, nurses, teachers, social workers, and law enforcement officials are required to file care card and cicp.

How to fill out care card and cicp?

Care card and cicp can be filled out online or by submitting a physical form with all the required information.

What is the purpose of care card and cicp?

The purpose of care card is to report suspected child abuse cases, while cicp provides compensation for children who have been injured as a result of abuse or neglect.

What information must be reported on care card and cicp?

Information such as the child's personal details, description of the abuse or injury, and any witnesses or evidence must be reported on care card and cicp.

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