Eligibility to be Seen at FFACTS Clinic
To be seen at this clinic, patients must provide evidence of an HIV or AIDS diagnosis, proof of income and proof of residency. We walk you through the process of obtaining the necessary documents so you can start care and begin your personalized treatment plan.
The state requires proof of income, residency and positive diagnosis for patients to receive grant funding.
Preparing for Your Appointment
If you qualify, we encourage you to apply for Ryan White Grant funding to cover your medical costs. To help determine if you’re eligible before your visit to our clinic, a member of our registration team will review your documents to verify your income, proof of residency, proof of insurance (or lack of) or eligibility for CareLink.
We recommend that you fill out the following Ryan White Grant forms in advance. Clients can send completed Ryan White grant forms to regdocs@uhtx.com.
- Supporter statement [PDF] (en español)
- Declaration of income statement [PDF] (en español)
- Statement of no income [PDF] (en español)
- Declaration of residency [PDF]
- Attestation form [PDF] (en español)
- Permission to share information [PDF] (en español)
- E2SA consent [PDF] (en español)
- Rights and Responsibilities [PDF] (en español)
- Physician’s Consent for Treatment [PDF] (en español)
- HIPAA Notice of Privacy [PDF] (en español)
What to Expect at Your First Appointment
Please arrive for each appointment 15 minutes before your scheduled visit. A case manager will discuss available services and talk to you about your health care needs and help you schedule initial appointments. Ongoing appointments will be scheduled by a member of our nursing or registration team.
