Skip to Content
Agencies | Governor
Search Virginia.Gov
Protecting You and Your Environment Virginia Department of Health
Home | VDH Programs | Find It! A-Z Index | Newsroom | Administration | Jobs
   disclaimer

Chesterfield Health District Service Eligibility Information


Eligibility requirements vary depending on the service provided. Some services are free, some are a flat fee and others have a fee based on a sliding scale. Sliding scale means that the fee is relative to your income. Financial eligibility is determined annually and whenever there is a change in financial status. You must have identification and proof of income when services are provided.

Proof of Income – you will be required to provide one or more of the following:

  • Pay Stubs - provide either the most recent with "Year to date" income listed, or 3 most recent
  • W-2 Form or income tax return for most current calendar year
  • Employer's written statement regarding weekly, monthly, or yearly gross income
  • Unemployment notice from VEC (Virginia Employment Commission)
  • Letter of Termination/Layoff notice from previous employer
  • Statement of Social Security benefits or other benefits
  • Military LES (leave and earning statement)
  • Foster care statement from Social Services
  • Food stamps - Letter of eligibility
  • TANF
  • Medicaid card for current month
  • Free or reduced school lunch - letter of eligibility (WIC and Dental Programs Only)
  • Minors if not working must provide parent’s income to determine eligibility

Proof of Identity

  • Medicaid Card/HMO Card for each person being certified
  • Driver's License
  • Birth Certificate or Crib Card
  • Social Security Card

Proof of Virginia Residence

  • Medicaid Card/HMO Card for each person being certified
  • Driver's License
  • Rent/Mortgage Receipts

Please bring Shot Records if you have them.

If you have questions or need more information regarding eligibility requirements, please call 748-1750.


Last Updated: 10-06-2011

Printable Version

E-mail This Page