Uniform County Medical Assistance Application

MEDICAL ASSISTANCE

USE THIS FORM ONLY FOR ASSISTANCE WITH:

• Medical Bills
• Medication Costs
• Cobra Insurance Premiums

Please Note: Files formatted in Portable Document Format (PDF) require the Adobe Acrobat Reader to access.
You can download the free reader directly from Adobe. Acrobat and the Acrobat logo are trademarks of Adobe Systems Incorporated.
 

Medical Application

Uniform County Medical Assistance Application

MEDICAL ASSISTANCE

USE THIS FORM ONLY FOR ASSISTANCE WITH:

• Medical Bills
• Medication Costs
• Cobra Insurance Premiums

Please Note: Files formatted in Portable Document Format (PDF) require the Adobe Acrobat Reader to access.
You can download the free reader directly from Adobe. Acrobat and the Acrobat logo are trademarks of Adobe Systems Incorporated.
 

Medical Application