True or False
SFD Program
BONUS
100

When a patient misses their 3rd unexcused appointment, the PSR who enters the third FYI Flag will notify both the provider and the clinic's Practice Manager.

True.

100

What required documentation can a patient provide as POI? Name at least 3 different forms. 

Wages/Salaries-30-day pay stubs (gross pay) 

Self-Employment-Schedule C, Line 31

Farming Income -Schedule F, Line 34

SSA-1099 or Benefit Verification Letter

1099-R or letter from Retirement/Pension paying agency 

Unemployment letter from paying agency 

Child Support/Alimony court order or letter 


200

If CHW-related issues have been previously identified, the CHW must respond to the PSR's in-basket message within 24 to 72 business hours. 

True

200

If a patient chooses not to disclose their annual income or apply for our sliding fee discounts, what FPL entries would you use? 

Status: 

Reason:

Proof of Income: 

Status: Incomplete

Reason: (blank) 

Proof of Income: Proof not provided 

300

If a patient is placed on a walk-in basis status, the provider is responsible for informing the patient about the alternative scheduling status.

False.

300

What missing information makes an SF APP incomplete? 

Any 

500

What month and year did Daisy (Cheri) create the Income Verification Guide for us? 

September of 2024

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