Adult Patient Registration

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS

HEALTH DEPARTMENT

1260 AJIJAAK AVE

PETOSKEY, MI 49770

P: 231-242-1700

ADULT PATIENT REGISTRATION

REQUIRED DOCUMENTATION

Use this list to ensure you provide the LTBB Health Department with all required documentation. Failure to do so will result in delay of your care.

Document Checklist:

Tribal Identification Card from a Federally recognized Tribe (State Recognized Tribes are not eligible) OR Proof of descendency from a Federally Recognized Tribe

Birth Certificate

Social Security Card

Driver's License OR State Identification card (must include a photo, name, address, and date of birth)

Two (2) proofs of physical address (no RV parks or PO boxes accepted)

All active insurance cards (medical, dental, vision)

Completed Registration Packet

Any legal documents relevant to patient care (legal guardianship, adoption, foster care, power of attorney related to medical services)