Intake Form

REMIND Client: Remind Clients requiring Case Management Intake to bring: Florida Photo ID, Proof of HIV (Western Blot, HIV antibody test or detectable viral load), utility bill or other proof client is residing at a Florida address, Proof of Income (SS! letter, 3 recent check stubs, income tax return, or letter of support if no income). MUST BRING ALL INSURANCE CARDS INCLUDING MEDICARE B AND D. Other case management agencies who refer clients MUST provide the above documents along with a current letter of eligibility.