Publications & Forms

HOUSEHOLD ASSESSMENT
PATIENT DISCOUNT ELIGIBILITY FORM

Discount Policy: Daughters of Charity Health Centers determine eligibility for patient discounts based on the patient’s household assessment determined by family income and family size.

Payment Policy: Daughters of Charity Health Centers collect all applicable payments, co-payments, and/or deductibles at time of service. 

Daughters of Charity Services of New Orleans is committed to improving the health status of our community. We continue to advance our long tradition of health ministry through the development of a values-driven organization dedicated to primary care and preventive health services, addressing the needs of the total individual – body, mind, and spirit.

We provide discounts to uninsured patients based on family size and household income. Therefore, in order to make your visit to our Health Center as pleasant as possible, please bring the following documents with you to your visit:

a. Driver’s license or photo ID
b. Insurance card, if applicable
c. Proof of income (pay stub, Social Security, etc)

Thank you for choosing us for your health care needs. We look forward to serving you!