South carolina department of health and human services family planning application form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in Section 1. Fill in your full name, place of birth, mailing address, and contact details. Ensure accuracy as this information is crucial for processing your application.
3. In Section 2, indicate whether you have health insurance that covers doctor visits and lab tests. If yes, provide the necessary details about your insurance provider.
4. Proceed to Section 3 to answer if you are currently receiving Medicaid. If applicable, confirm if you have your Medicaid card with you.
5. Section 5 requires information about family members living with you. List their names, relationships, birthdates, race, sex, and citizenship status as needed.
6. In Section 6, disclose any income sources for yourself or family members. This includes detailing the source and amount of income received monthly.
7. Finally, review the Rights and Responsibilities section before signing the application. Ensure all provided information is accurate before submitting it to your local Medicaid eligibility office.

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