Health Network Requirements

Are you ready?

Health Network Enrollment Packet [English]

Health Network Enrollment Packet [Creole]

Health Network Enrollment Packet [Portuguese]

Health Network Enrollment Packet [Spanish]

Enrollment is free and must be initiated by the clinic. A patient cannot enroll him/herself.

The 3 things required for enrollment are:

1. CONSENT FOR RELEASE OF MEDICAL INFORMATION section (signed and dated)
2. PARTICIPANT INFORMATION SHEET section (including the patient’s working phone number(s) and intended address)
3. Medical records and/or summary of next steps

Enroll in Health Network Here