qaa Lyiin'inh
ICHC: Patient Information
ICHC: 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 and Information
Patient Registration Form
Please fill out this form if you are a new patient.
Refill Request Form
Please fill out this form if you are requesting a prescription refill.
Treatment of Consent for Minors
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.
Release of Information
This form authorizes ICHC or another entity to release health information to a specific organization or individual.
CDL
This form is needed for a commercial driver’s license physicals.
School Entry Physical
Please fill out the School Entry form if your child will be entering school for the first time.
Sports Physical
Please fill out the Student Health Review/Exam form if your child is needing a physical for school sports.
Ladies First assists eligible Alaskans in getting breast and cervical health screenings.
Frequently Asked Questions
How do I apply for the Sliding Fee Discount?
Please fill out the Sliding Fee Discount form. Bring your form and required documents into Ilanka Community Health Center.
Where can I get my prescription filled?
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.
How do I get my prescription re-filled?
To re-fill your prescription please fill out the Prescription Refill form.
Language Assistance
The Ilanka Community Health Center uses a phone-based interpreter service. These services are offered at no cost to the patients.
The services offer language assistance to over 200 languages.
IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY PLEASE CALL 9-1-1.
Location,
Contact & Hours
PO Box 2290
705 Second St
Cordova AK, 99574
Phone: (907) 424-3622
Fax: (907) 424-3275
Email: IlankaCHC@eyak-nsn.gov
Hours:
Monday-Friday: 8:00 AM – 5:30 PM
Saturday: 8:00 AM – 12:00 PM
Closed Sunday
Nurse Line: After hours and on holidays (907) 424-3622
After Hours Information
If you are experiencing a medical emergency, please call 9-1-1 or go to your local emergency room.
The After Hours Nurse line can assist you after hours or on holidays. Please call (907) 424-3622 and follow the prompts to be directed to the nurse line.
Questions, Comments, Concerns?
Do you have a question, comment, or concern about the care you received at ICHC? Please fill out the Comment Form.
