Forms

Kidney Health Care Client Forms

KHC Client Application Checklist (PDF)
Form 3035 - KHC Client Application
Form 3057 - KHC Physician Assessment
CMS 2728
Direct Deposit (PDF)

Kidney Health Care Travel Forms

KHC Travel Form (PDF, English)
KHC Travel Form (PDF, Spanish)

Kidney Health Care Insurance Update Forms

KHC Medicare Part D Update Form (PDF)
KHC Insurance Update Form (PDF)

Kidney Health Care Publications

Kidney Health Care has a flyer that provides basic information about the program to new applicants. KHC recognizes that many times clients can be overwhelmed when they apply for the program. This flyer aims to help them understand the program’s role in managing their kidney disease.

You just applied to KHC! (PDF, English)

¡Acaba de solicitar KHC! (PDF, Spanish)

Guide to your KHC Benefits / Guía a sus beneficios de KHC para medicamentos (PDF)