Indian Health Service Purchased/Referred Care Proof of Residency

The IHS Purchased/Referred Care Program needs this information to certify that the health care services requested and authorized by the IHS have been provided to individuals who documented to meet the eligibility requirements to receive medical services for Purchased/Referred Care provider(s). It is also to serve as a legal document for health and medical care authorized by IHS and rendered by health care providers under contract with the IHS.

The latest form for Indian Health Service Purchased/Referred Care Proof of Residency expires 2022-03-31 and can be found here.