Employee Verification Letter (EVL)
EVL must contain the following items:
- Applicants full name
- Contact information of employer
- Dates of employment and employment status (part time/full time)
- Brief summary of responsibilities and duties of the employee
- Patient Services
- Geographic area (counties served)
- Medicare/Medicaid provider numbers (if applicable)
- Must be signed by employer on official letterhead
Governmental ID
- Official Drivers License or Official Photo ID.
Medicare/Medicaid Acceptance
- Provide Medicare NPI# and/or Medicaid Provider #. (if applicable)
Governmental/Federal Affiliation Documentation
- Proof of Federally Qualified Health Centers, Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Health Centers for Residents of Public Housing.
Tribal Affiliation Documentation
- Proof of Tribe, Tribal Organizations and/or Urban Indian Health Centers.
501(C)(3) Documentation of Non-Profit Status
- Proof of 501(c)(3) Non-Profit Form.
Sliding Fee Scale Documentation
- The health center’s sliding fee scale document and/or related policies and procedures for determining sliding fee eligibility and applying sliding fee discounts.
Policy To Treat Patients Regardless of their Ability To Pay Documentation
- Brief documentation outlining this policy within the health center.
Loans
- Student loans must be dated within the last 90 days.
- Loans eligible for repayment assistance are any educational loans obtained for tuition, educational expenses, or living expenses from a college, university, government, or commercial source.
License/Certification
- Current New Mexico Professional License. (mandatory)
- Additional certifications may be uploaded to your HPLRP application.