CallRuby Intake Form

Important:

Do not enter anything other than single patients name. Leave blank and place info in note section if you're not sure.

How to find Medicaid number?
  1. The ID # is on the Medicaid Card under the "B".
  2. Some people refer to card as Medicaid CardBenefits Card, or Food Stamps Card. Use all 3 terms if caller is not sure what ID # we need.
  3. The ID # is always in same Alphabetical-Numerical Sequence: 2 Letters, 5 Digits, 1 Letter. ex. YS12345W
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