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ICHC: Patient Information
Frequently Asked Questions
Please fill out the Sliding Fee Discount form. Bring your form and required documents into Ilanka Community Health Center.
You can get your prescription filled at The Cordova Community Medical Center Pharmacy here in Cordova. We can also send your prescription out of Cordova if you prefer to have it mailed. If you choose to do this, please provide the name, phone number, and fax number for the pharmacy of your choice.
To re-fill your prescription please fill out the Prescription Refill form.
HAVE QUESTIONS? CALL US
DOCUMENTS & QUICK LINKS
If you are experiencing a medical emergency please call 9-1-1.
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qaa Lyiin'inh. Patient Information
The Ilanka Community Health Center provides personalized, quality health care for the entire community as a recognized “Patient Centered Medical Home”. We put patients first by including them in all aspects of their care and empowering them to seek the best solution for management or treatment.
How to Register
Registration can be a quick and painless process. Please follow these four steps to make your experience as efficient as possible and feel free to contact us if you have any questions.
Please print and complete this packet.
Do you qualify for the sliding fee discount?
You can reach us at (907) 424-3622 or visit us at 705 2nd St, Cordova AK
Please arrive 20 minutes early to your first appointment.
Need to bring:
- Insurance Card
- Any Current Medications
- Current Address and Phone Number
- Immunization Records
- Previous Medical Records
- Proof of Income if applying for sliding fee.
- Payment for your visit
- Additional paperwork or forms for your provider (disability, CDL, Workman’s Comp, etc.)
Patient Forms
Please fill out this form if you are a new patient.
Please fill out this form if you are requesting a prescription refill.
This form gives consent to another individual who is not the parent or guardian to approve care of a minor at ICHC. Examples include parents who will be out of town and the child stays with friends or relatives.
This form authorizes ICHC or another entity to release health information to a specific organization or individual.
This form is needed for a Commercial Driver’s license physicals.
Please fill out the School Entry form if your child will be entering school for the first time.
Please fill out the Student Health Review/Exam form if your child is needing a physical for school sports.
Please fill out this form if you have a question, comment, or concern about the care you received at ICHC.
Ladies First assists eligible Alaskans in getting breast and cervical health screenings.
This form information sheet describes what a referral is and the referral process.
Language Assistance
The services offer language assistance to over 200 languages.
