WCMS Project Access® referral form
Instructions: Form is to be completed by the provider or an authorized staff member and submitted online. Project Access® will contact your office once the patient has completed the entire screening process and is enrolled. As the provider, you agree to see the patient free of charge.
To be enrolled, patients must meet all three of the following criteria:
- At or below 138% of Federal Poverty Level
- Resident of Buncombe or Madison County for the last 12 months
- Uninsured- this includes Medicare Part A, Medicare Part B, Medicaid (Family Planning only is OK), Tricare, and any other insurance plan such as employee-sponsored or purchased on the ACA Marketplace.
We are unable to accept referrals for any injuries related to a motor vehicle accident or on-the-job accidents.