Jackson County Health Department

Promoting Health, Preventing Illness, Protecting our Environment and Preparing for Emergencies

HIV/AIDS Client Forms

Please print your form, complete it then send it to Care Connect by scanning the form and emailing it to This email address is being protected from spambots. You need JavaScript enabled to view it., fax to 618-687-4933 or mail to - Care Connect, P.O. Box 307, Murphysboro, IL 62966.

Travel Voucher

Emergency Assistance Request Form (Rent/Mortgage/Utility)

Illinois Ryan White Monthly Household Income Statement

Notice of Privacy Practices

IL Ryan White Authorization to Release Form 

SIHCC Grievance Policy and Procedure Form

 

For additional information, please contact your case manager (618) 684-3143, ext. 155 or (877) 745-1424.

 

 

 

 415 Health Department Road

Murphysboro, IL 62966

Monday - Thursday 8AM - 5PM

Closed Fridays

 

 

 

 618-684-3143

Click here to email us

After Hours Emergencies 800-875-0162

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