PATIENT INFORMATION  (Page Down for 2019 Sliding Scale)

The Margaret B. Shipley Child Health Clinic, Inc. is a program of health supervision for your child from birth to 18 years of age. This program includes: sick and well child health care, evaluations, laboratory (blood and urine), Developmental screenings, speech, hearing and vision checks, immunizations, health and nutrition teaching, support programs referrals, social services and counseling, and 24-hour medical coverage.

The clinic is in operation Monday through Thursday from 8:00 AM to 4:30 PM and Friday from 8:00 AM to 4:00 PM. Each child must have an appointment and we discourage walk-ins. If you do walk in, we will schedule your child for the first available appointment. We encourage you to be on time for your appointment. If you need to schedule, reschedule or cancel an appointment, you may call the clinic at 330-453-3386. If you need to cancel an appointment after regular business hours, you may leave that information with answering. A copy of these policies is given at the first visit. Please retain this for future reference.

The immunizations that are given to your child will help to prevent certain childhood illness and are required for school entrance. If you’ve been given a card to record these immunizations, please bring it with you to each visit. We record immunizations in each child’s medical chart and enter the data on the Ohio Department of Health’s website. This allows our state to monitor the immunization status of its children. It also enables other doctors to access a child’s immunization history to avoid unnecessary vaccinations. If you do not want your child’s immunization status recorded with ODH, please request a form from the front desk.

If your child has forms that need completed, please allow at least 48 hours. We suggest that you call first to make sure the forms are complete and the doctor has signed them. In the event that your child has had a lead screen, the results of these are recorded one time per week.

We see all children regardless of ethic background or social status. If you have medical coverage, we may ask to see your card to verify that information at each visit. If you do not have coverage, you will be asked to complete a financial form and prove income. Families may be placed on sliding fee scale based on income and family size.  Your child will not be refused care due to an inability to pay. Families will be treated with respect and courtesy. (Sliding Scale Below)

Please call the clinic at 330-453-3386 during regular business hours to schedule your child’s first visit.

 

          MARGARET B. SHIPLEY CHILD HEALTH CLINIC            
                                   
            SLIDING FEE SCALE - 2019                
                                   
  100% FPG 100% FPG       STEP 1       STEP 2       STEP 3       STEP 4       STEP 5  
NO. IN Annual Monthly                              
FAMILY No No   Patient Pays 15% of Fee     Patient Pays 35% of Fee     Patient Pays 55% of Fee     Patient Pays 75% of Fee     Patient Pays Full Fee  
  Charge Charge   (85% Discount)     (65% Discount)     (45% Discount)     (25% Discount)     (No Discount)  
                                   
1 12490 1041 1042 -1431   1432 -1822   1823 -2212   2213 -2602   2603 -  
                                   
2 16910 1409 1410 -1938   1939 -2467   2468 -2994   2995 -3523   3524 -  
                                   
3 21330 1778 1779 -2444   2445 -3111   3112 -3777   3778 -4444   4445 -  
                                   
4 25750 2146 2147 -2951   2952 -3756   3757 -4560   4561 -5365   5366 -  
                                   
5 30170 2514 2515 -3457   3458 -4401   4402 -5342   5343 -6285   6286 -  
                                   
6 34590 2883 2884 -3963   3964 -5045   5046 -6125   6126 -7206   7207 -  
                                   
7 39010 3251 3252 -4470   4471 -5690   5691 -6908   6909 -8127   8128 -  
                                   
8 43430 3619 3620 -4976   4977 -6335   6336 -7691   7692 -9048   9049 -  
                                   
                                   
Families that qualify for expansion should be encouraged to apply for Medicaid rather than be on sliding scale  
                                   
Families should be made aware when they are eligible for ACA Subsidy                 
                                   
Families MUST provide current pay stub or most recent IRS return to be placed on Sliding Scale      
                                   
Steps are listed for GROSS (before taxes) monthly pay.                    
                                   
VERIFICATION:   IRS - Annual Gross Income /12 months = Monthly Income            
      Weekly pay check stub - Gross Amount x 52 / 12 = Monthly Income        
      Bi-weekly (every other week) - Gross Amount x 26 / 12 = Monthly Income      
      Semi-monthly (twice a month) - Gross Amount x 24 / 12 = Monthly Income      
      Monthly - Gross Amount = Monthly Income                
                                   
From Federal Register 2/2019