This form can help you guide your patient to access financial services with the new casebook elegibility criteria.
**If your patient's income is 0, please select <100%
To better assist your patient, we need to know where their income falls according to the Federal Poverty Level (Federal poverty levels are used to determine your eligibility for certain programs and benefits). You can find this out by using the calculator listed above. Please click on the provided link, calculate the FPL percentage, and come back here with the answer.
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