Community Health Care Network Enrollment and Services
CHCN Enrollment Requirements
A person may be eligible for CHCN if he/she:
- Lives in Fairfax County, the City of Fairfax, or the City of Falls Church
- Does not have access to primary health care
- And has a family income at or below 200 percent of the Federal Poverty Level
Applications are taken in person at the health centers.
Print an Enrollment Checklist Form (English and Spanish)
Print Verification of Income and Health Insurance Form (English and Spanish)
Documentation Needed for Enrollment:
- One full month of current pay stubs for every employed household member or a written record of weekly earnings for anyone who receives cash for day labor work.
- Every employed household member who is 18 years or older must have their employer complete information about health insurance with their job. The Verification of Income and Health Insurance form will be given to you at the interview if you have not yet received it. The Health Insurance Section – Part II must be completed by the employer. Part I can be completed by the employer if you do not have current pay stubs.
- Proof of any unearned income such as Unemployment, VA Benefits, Pensions, Retirement, Alimony or Child Support. Examples are: copy of the check, bank statements for direct deposits, award letters or a divorce decree.
- Signed copy of your most recent federal tax return with all schedules for yourself. If you are claimed on another person’s taxes, please bring that tax return.
ID for all household members such as:
-Photo identification card
-School report card or shot records
-Permanent resident card or passport
Proof of 9-Month residence in Fairfax County and current address.
Please bring one of the following:
- -Current lease or mortgage statement
- -Current car registration
- -Current utility bill
- -Other - official letters from any federal, state or county agency
NOTE: You must also provide something that shows you have lived in Fairfax County for at least 9 months.
- Minor emergency care
- Care of acute and chronic diseases
- Check-ups, vaccinations, flu shots
- Laboratory services
- Limited x-ray services at some sites and referrals for diagnostic services
- Limited pharmacy assistance
- After hours consultation
- Limited referrals to participating physicians for specialized care
- Referrals to certain services offered at Health Department district offices and other County and nonprofit organizations
- Limited behavioral health services
- Nutrition Services
- For people without insurance who live in Fairfax County and the Cities of Fairfax & Falls Church (proof of address required)
- $20 per visit
- Birth Control Services
- No Appointment Necessary
- Services provided on first come, first served basis, while space is available