Annual Requalification - Existing Mariam Clinic Patients
Each year all existing Mariam Clinic patients are required to go through a re-qualification process. To re-qualify please read the eligibility requirements below and submit the required documents outlined in the "Required Documents" section below along with the Intake Form.
Must not qualify for public or private insurance (i.e. Medicaid, Medicare, NC Health Choice, Disablity or Veterans’ Benefits).
Must be Permanent Resident of Wake County.
Household income no more than 200% of the poverty level (to view poverty level, click here).
Due Date Required Documents
2/1/23-3/31/23 1. 2022 W2 & 3 2023 Paystubs for all working household members
2. Letter of Support - Notify Mariam Clinic & we will provide this form
3. Income Verification Form - Notify Mariam Clinic & we will provide this form
5/1/23-5/31/23 Tax Form 1040 for 2022
How to submit your documents
1. Mail: Mariam Clinic 4441-106 Six Forks Rd Ste 388 Raleigh NC 27609
2. Walkin: drop your documents off at the front desk on Sunday
3. Email: email@example.com - PDF only, no photographs
If you are unable to provider the required documents by the deadline please contact the clinic 919-824-4672