This is a Congregate Care Level II program. Any individual not qualifying for DSS funding will qualify for a sliding fee scale.

The following documentation is needed prior to admission to The Patricia Pond Hinckley Women’s Intensive Residential Program:

__________ Current Bio/Psych/Soc Evaluation

__________ Physical (by MD only), with required blood work, done within the past
                   6 months or less

__________ Pregnancy Test, if needed and/or statement of health from the
                  OBGYN

__________ TB

__________ Tetanus

__________ Blood and Urine Screens – CBC, UA, Full CHEMISTRY Profile

__________ Birth Certificate

__________ Social Security Card

__________ Photo Identification

__________ Mental Health / Psychiatric Information

__________ Legal Information / Court Order

__________ Insurance / Medicaid Information, original card needed

__________ Public Assistance Verification, with name and phone number of the                   County Case Worker