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South Broward Community Health Services Application and Eligibility Guidelines

Here are step-by-step instructions to apply for – or renew – a South Broward Community Health Services Identification Card, followed by a list of documents required to determine eligibility.

New South Broward Community Health Services Card Applications

Choose one of the following options to submit your completed Financial Evaluation Form and copies of all the requested documents:

  • Mail to: Memorial Healthcare System, PO Box 863436, Orlando, FL 32886-3436, Attn: South Broward Community Health Services Eligibility
  • Fax to: 954-602-2800, Attn: South Broward Community Health Services Applications
  • Drop off copies of your documents in one of the "drop boxes" located at:
    • South Broward Community Health Services, 4105 Pembroke Road, Hollywood, Florida
    • Memorial Outpatient Center, 1750 East Hallandale Beach Boulevard, Hallandale Beach, Florida

If you are approved, you will receive your South Broward Community Health Services Card in the mail. You will also be notified by mail if your application is denied, or if there are questions.

If you prefer to submit your documents in person, please go to Memorial Outpatient Center, Office 2 or 3, 1750 East Hallandale Beach Boulevard, Hallandale Beach, Florida. Call 954-457-0500 for hours of operation.

A copy of your photo ID must be submitted with your documents.

South Broward Community Health Services Card Renewals

You can renew your South Broward Community Health Services Card by submitting a completed Financial Evaluation Form (linked below), along with copies of all of the requested documents, by one of these methods:

  • Mail to: Memorial Healthcare System, PO Box 863436, Orlando, FL 32886-3436, Attn: South Broward Community Health Services Eligibility
  • Fax to: 954-602-2800, Attn: South Broward Community Health Services Card Renewal
  • Drop off copies of your documents in one of the "drop boxes" located at:
    • South Broward Community Health Services, 4105 Pembroke Road, Hollywood, Florida
    • Memorial Outpatient Center, 1750 East Hallandale Beach, Boulevard, Hallandale Beach, Florida

If you are approved, your South Broward Community Health Services Card will arrive by mail. You will also be notified by mail if your application is denied, or if there are questions.

Or, you may submit your documents in person by either:

  • Calling 954-457-0950 for an appointment, or
  • Stopping by Memorial Outpatient Center, Office 2 or 3, 1750 East Hallandale Beach Boulevard, Hallandale Beach, Florida; call 954-457-0500 for hours of operation

A copy of your photo ID must be submitted with your documents.

Required Documents

Copies of the following documents must be presented to determine eligibility. A South Broward Community Health Services Identification Card cannot be issued until eligibility is established.

Citizenship:

  • A United States passport, voter's registration card or birth certificate and Social Security card for each member of the household

Picture ID: 

  • A Florida ID or driver's license (must list current address) or a resident alien card, employment authorization card and Social Security Card
  • A valid passport with visa and I-94 card (if you do not have a Florida driver's license or Florida ID)

Proof of Medicaid Application:

  • Must provide a Department of Children and Families access number (see Medicaid section below)

Proof of Address (please provide one of the following):

  • Current utility bill (e.g., electricity, telephone, gas, water or cable) addressed to you or your spouse; if the utility bills are NOT in your name, you must bring a notarized letter from the person whose name is on the bill stating that you live at that address and a copy of a current utility bill
  • Voter's registration card
  • Lease agreement

Proof of Income (all household income MUST be provided):

  • If married, spouse's income must be provided
  • An unmarried parent must provide income from both parents if they are living in the same household
  • If you are separated, you must provide your spouse's income
  • Consecutive and complete paycheck stubs for your last six (6) weeks of employment
  • If you cannot provide pay stubs, you must obtain a dated letter from your employer, on company letterhead, stating hours worked and gross pay
  • Unearned income (e.g., AFDC, alimony, child support, disability income, Social Security income, unemployment compensation, and pensions)
  • All pages of your most recent income tax return, including W-2 forms, 1099s and all schedules for you and your spouse
  • Last three (3) consecutive bank statements for you and your spouse (you may be asked to provide proof of paid monthly bills if you do not have a bank account)

If you do not have documented income, and are being supported by another person, you must provide a notarized letter of support from the person who is helping you, and a copy of supporter's picture ID. This letter cannot be older than 30 days, and must state how long the person has been supporting you.

Please allow 90 days for processing and review.

Medicare:

If you have Medicare, or will be eligible for Medicare, please submit a copy of your card or of the document stating when you will be eligible.

Medicaid:

If you have applied for Medicaid already, you must include a copy of your application in the documents you submit to South Broward Community Health Services (Medicaid access number or Medicaid approval or denial letter).

South Broward Community Health Services Eligibility Medicaid Screening:

Please answer the following questions if you are applying for South Broward Community Health Services.

  1. Are you a United States citizen or a legal resident for five years or longer?
  2. Are you 65 or older, or receiving disability benefits?
  3. Do you have any dependent or adopted children under 18 years old?

If you answered yes to Question 1 and Question 2 or 3, you must apply for Medicaid prior to your scheduled eligibility appointment.

You must provide proof you have applied for Medicaid (access number), along with all of the required documents (see above).

(Please go to http://www.myflorida.com/accessflorida/ and click on "Apply for Benefits" to complete a Medicaid application.)

Proof of Legal Guardianship (if applicable):

If you are a legal guardian, you must provide us with the proper custody or legal documents.

Additional Information and or documentation may be requested to complete your application. All information is subject to verification. Providing false information may result in the denial of any type of financial assistance through the South Broward Hospital District d.b.a. Memorial Healthcare System.

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