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Application Verifications


Some Verifications May Be Required

Eligibility for State medical programs is determined by: Citizenship, Residency, Family Size, Age, Income, Resources, Family Deprivation, and Pregnancy. Family Deprivation exists when a parent is: Deceased, Blind, Disabled, Incapacitated, Absent, or Under-Employed. Certain documentation is required to verify household composition and circumstances so that eligibility can be determined.

Some of the following verifications may be required for all household family members. Time limits will be required.  Please locate and have available any applicable documents to ensure and expedite your eligibility determination.  You may also request assistance in making verification copies and delivery to Health & Human Services. (The more common required verifications are highlighted below)

NOTE: The State of California requires proof of Citizenship for Medi-Cal eligibility.  Verification such as a “Certified” Birth Certificate or Passport is required.  The original document (not copies) must be presented for viewing and copying at Del Norte County Department of Health & Human Services. 

  • Citizenship: Certified Birth Certificate ~ Nationalization Form ~ Alien Registration Card
  • Identification: Social Security ~ VA ~ Medicare ~ Picture ID Cards ~ Passport
  • Residence: Rent ~ Lease ~ Mortgage ~ Property Tax ~ Utilities ~ Provider Statement
  • Vehicles: DMV Registration:  Auto ~ Motorcycle ~ Boat ~ Trailer ~ Camper ~ RV
  • Resources: Bank Statement: Checking ~ Savings ~ CDs ~ Stocks ~ Bonds ~ Cash
  • Property: Real-estate ~ Mineral Rights ~ Livestock ~ Guns ~ Jewelry ~ Instruments
  • Earned Inc: Wages ~ Tips ~ Self Employment ~ Farming ~ Fishing ~ Rental Property
  • Unearned Inc: SSA ~ VA ~ Unemployment ~ GA ~ Disability ~ Work Comp ~ Child Support
  • Marital Status: Marriage License ~ Absent Parent ~ Child Support ~ Pregnancy
  • Insurance: Life Insurance ~ Burial Policy ~ Health & Medical Insurance Information
  • Expenses: Child Care ~ Child Support ~ Health Insurance & Medical Payments



This site is intended as a resource to provide Sutter Coast Hospital Patients better access to free or low cost medical coverage. For more help and information contact:


Debbie Youtsey - Patient Services - Sutter Coast Hospital

800 E. Washington Blvd. PO Box 2009 Crescent City CA 95531

Phone: (707)464-8960      Fax: (707)464-8839



Official Sutter Web Sites:  Sutter Coast Hospital   Sutter Health   Find a Doctor