To apply for sliding fee discounts, fill out CHP’s Sliding Fee (Discount) Eligibility Form English (PDF), or Spanish (PDF). Include everyone in your household:

• Who you help to support or
• Who helps to support you.

Bring this form AND documentation of your household income when you come for your visit.

Provide at least one proof of income for all working household members 18 years and older:

• Most recent tax return
• Most recent W-2’s
• Last 3 pay stubs
• One check stub for unemployment income
• Social Security, retirement, disability or TANF benefit letter
• Most recent 1099 form
• Letter from employer including pay rate and average hours worked in a week

Below are the ways you can request your medical records from Community Health Partners. This will allow you to share them with another provider or to supplement insurance records.

My Chart

1. 1. If you have My Chart, log in to My Chart to access your medical records, including prescriptions and lab results. If you need more information outside of what is in My Chart you can send a request to CHP Medical Records within My Chart.
   2. If you do not have My Chart: select the link to sign up for My Chart.

1. Release of Medical Records Form: You can use the Authorization for uses and disclosures of protected health information (PHI) form to request the information that you need. This form can be downloaded and then returned in person or by fax to 406.388.3461. Note: you will be required to provide a valid form of picture ID at pickup.

If you have questions or want to be sure you have prepared everything that is required to get the records that you are looking for, call 406.922.0840.

19 E. Main Street
Belgrade, MT, 59714
M - TH: 8:00 AM - 5:00 PM
Phone: 406.922.0840
Fax: 406.388.3461

1. 1. If you have My Chart, log in to My Chart to access your medical records, including prescriptions and lab results. If you need more information outside of what is in My Chart you can send a request to CHP Medical Records within My Chart.
   2. If you do not have My Chart: select the link to sign up for My Chart.
2. Release of Medical Records Form: You can use the Authorization for uses and disclosures of protected health information (PHI) form to request the information that you need. This form can be downloaded and then returned in person or by fax to 406-587-6007. Note: you will be required to provide a valid form of picture ID at pickup.

If you have questions or want to be sure you have prepared everything that is required to get the records that you are looking for, call 406-922-0840.

Yes. CHP provides access to medical, behavioral health, and dental services for everyone. This includes people with limited incomes, no insurance, and all types of health insurance including high deductible and catastrophic-coverage-only plans. We also accept Medicaid, Healthy Montana Kids (HMK), and Medicare.

CHP provides care to everyone regardless of ability to pay. You may qualify for sliding fee discounts based on your family size and family income. Even if you have insurance coverage, sliding fee discounts can help with your deductible and co-pays.

• Photo identification
• Bottles of any medications you are currently taking or prescribed
• Insurance cards, if you have them
• Income documentation if you would like to apply for sliding fee discounts.

If all members of your household are unemployed with no sources of income, or you are not able to provide proof of your income, we will follow up with a meeting or phone call to discuss how you may qualify for the discount.

Yes, we accept Medicaid, Medicare, Healthy Montana Kids (HMK), and private insurance and we will bill your insurance. Some plans common in Montana include:

• Aetna Insurance
• Allegiance Health
• Blue Cross Blue Shield
• Cigna
• Delta Dental
• Montana Health Co-Op
• Pacific Source
• Tricare
• United Healthcare

These are just a few of the insurance carriers that we will bill for you.

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