Assuring Access to Healthcare for ALL
Al-aqsa clinic is now a member of Guilford Community Care Network (GCCN). Patients who qualify will receive the orange card from Eligiblity & Enrollment and are required to present this card at each visit.
Eligibility Requirements for GCCN
- You must be a resident of Guilford County.
- You cannot be eligible for state or federal sponsored healthcare insurance, including Veterans Administration, Medicaid, or Medicare.
- 0-200% FPL
- Photo ID such as driver’s license, state identification card, passport, or identification from home country.
- Proof of Guilford County Residency
Proof of Income (All that apply)
- 1040/Last year’s tax return ·
- W2 ·
- Notarized Schedule C for self-employment verification ·
- 1099 ·
- At least (4) current pay stubs ·
- (Form 4506-T)- If taxes were not filled the previous year.
- Other income: social security, unemployment, child support, workmen’s compensation
- Food Stamp Award Letter (if receiving assistance)-Informational Purposes ONLY
- Notarized Letter of Support (If you have no income and receive shelter from an individual/organization)
Proof of Assets (All that apply)
- Current Bank Statement (checking, savings, CD’s, etc…)
- If you are living on savings, you must provide three of your most recent bank statements.
- Life Insurance Info (Case Value/Company Name)
- Pension, 401-K, IRA, Gross Amount, etc…
- Tax Value on autos, property, houses, mobile homes, etc…(Informational Purposes ONLY)
- Disability Paper Work (if you have applied) Showing Status (Copy of Award Letter)
For College Students
- Documentation of how college is paid for (on school paper with logo) (print-out)
- Copy (print-out) of any award letters
- Copy of parental tax return
1908 S Mebane St Burlington, NC 27215