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1IHS CONTRACT HEALTH SERVICE PROVIDER MANUAL IHS form #001Rev 12/05/20142 IHS CONTRACT HEALTH SERVICE PROVIDER MANUAL 1. INTRODUCTION Effective July 1, 2000, the United States Public Health Services/Navajo
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How to fill out ihs contract health service

01
To fill out the IHS Contract Health Service, follow these steps:
02
Obtain the necessary application form from the IHS website or a local IHS service unit.
03
Fill in your personal information accurately, including your full name, address, and contact details.
04
Provide your tribal affiliation or status, if applicable.
05
Indicate the specific health services you need and the reason for seeking them.
06
Attach any supporting documents, such as medical records or referrals, if required.
07
Review the completed form to ensure all information is legible and correct.
08
Sign and date the form.
09
Submit the form to the designated IHS office or address provided on the application.
10
Keep a copy of the filled-out form for your records.
11
Follow up with the IHS office to check the status of your application.

Who needs ihs contract health service?

01
IHS Contract Health Service is available to individuals who meet certain criteria, including:
02
- American Indians or Alaska Natives who are members of a federally recognized tribe
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- Non-tribal members who are descendants of a federally recognized tribe
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- Individuals who possess Indian blood and are recognized as Indian for the provision of health services
05
- Individuals who reside within the IHS service area or tribal service area
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IHS Contract Health Service is a program that provides healthcare services to American Indians and Alaska Natives through contracts with private healthcare providers.
American Indians and Alaska Natives who are eligible for IHS services are required to file for IHS Contract Health Service.
To fill out IHS Contract Health Service, individuals can contact their local IHS facility or tribal health department for assistance.
The purpose of IHS Contract Health Service is to ensure that American Indians and Alaska Natives have access to necessary healthcare services that may not be available through IHS facilities.
Information such as the healthcare services requested, provider information, and patient demographics must be reported on IHS Contract Health Service forms.
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