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Form Instructions 843 Irvine California: What You Should Know

Or send mail to: Irvine Community Medical Center P.O. Box 2089 Irvine, CA 92 In order to make an appointment with the Kaiser Permanent clinic, call between 8 a.m. — 4 p.m. Monday through Friday. You need to provide information about: • Your name, • Your date of birth, • Your address, • If you have a child, what kind of child you have, the age, gender and whether you have any disabilities. • If your child is not a minor, they need to be in good health and free of illness or injury and under the age of 18. The clinic staff will make a recommendation about your case. The clinic staff will assess the severity of your problem and will make recommendations to the medical staff if appropriate. The medical staff will contact you to make an appointment for treatment. If you decide to see the clinic, they need to receive your information and address you and your child individually in their records. Irvine Community Medical Center is a member of Covered Orange County, a network of over 200 primary medical centers that offer a free or low-cost medical service to Covered Orange County residents. Covered Orange County is the largest of four insurance plans covering over 8.5 million Covered Orange County residents. When you are ready to go If you are not yet ready to make an appointment, you need to make plans now to make your treatment appointment with the clinic. You can call between 8 a.m. — 4 p.m. Monday through Friday. You need to provide information about: • Your name, • Your date of birth, • Your address, • If you have a child, what kind of child you have, the age, gender and whether you have any disabilities. • If your child is not a minor, they need to be in good health and free of illness or injury and under the age of 18. Irvine Community Medical Center is a member of Covered Orange County, a network of over 200 primary medical centers that offer a free or low-cost medical service to Covered Orange County residents. Covered Orange County is the largest of four insurance plans covering over 8.5 million Covered Orange County residents. Or send mail to: Orange County Community Medical Center P.O.

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