Eligibility Requirements
Thank you for your interest in becoming a patient of Providence Medical Clinic of Kingsport. Providence Medical Clinic is a free, faith-based medical clinic located in downtown Kingsport, serving the uninsured of Sullivan County and the Greater Kingsport Area. The clinic offers compassionate medical and spiritual care to those in need, providing acute care, primary care with specialty clinics. Providence Medical Clinic’s Staff of volunteer doctors, nurses, clerical and spiritual support are committed to excellence in medical care, love and compassion.
To become a patient of Providence Medical Clinic, you need to complete the attached application and bring it to the clinic, along with the required information listed below on any Monday, Tuesday, Wednesday or Friday from 9:00am –1:00pm; no appointment is necessary to return the required information.
Proof of Income
- Unemployment information and termination letter
- Copy of your most recent Federal Tax filing
- Last month of pay stubs from employer
- Disability Benefits
- Retirement Benefits
- Food Stamp Determination Letter
- Families First Benefits
- HUD Assistance
Proof of Residency
Please bring one of the following to show where you live:
- Copy of utility bill such as a home phone bill, water or power bill, bank statement, car insurance statement, hospital bill, etc. that shows your name and current address on it.
Letter of Support
- If living with a relative or friend, please bring a letter of support with name of the relative or friend, address, phone number, date and whether they are supporting patient financially and/or living expenses.
Proof of Identification
- Driver's License, State ID, or Student ID.
Eligibility Applications
Please pickup or return eligibility applications for Providence only on these days and times:
- Mondays, Tuesdays, Wednesdays or Fridays from 9:00am - 1:00pm.
- You do not need to call and make an appointment
Financial Guidelines
- Patients must have a household income that falls within our eligibility guidelines (below 150%)
| Household Size | 100% | 133% | 138% | 150% | 200% | 300% | 400% |
|---|---|---|---|---|---|---|---|
| 1 | $15,650 | $20,814.50 | $21,597 | $23,475 | $31,300 | $46,950 | $62,600 |
| 2 | $21,150 | $28,129.50 | $29,187 | $31,725 | $42,300 | $63,450 | $84,600 |
| 3 | $26,650 | $35,444.50 | $36,777 | $39,975 | $53,300 | $79,950 | $106,600 |
| 4 | $32,150 | $42,759.50 | $44,367 | $48,225 | $64,300 | $96,450 | $128,600 |
| 5 | $37,650 | $50,074.50 | $51,957 | $56,475 | $75,300 | $112,950 | $150,600 |
| 6 | $43,150 | $57,389.50 | $59,547 | $64,725 | $86,300 | $129,450 | $172,600 |
| 7 | $48,650 | $64,704.50 | $67,137 | $72,975 | $97,300 | $145,950 | $194,600 |
| 8 | $54,150 | $72,019.50 | $74,727 | $81,225 | $108,300 | $162,450 | $216,600 |
