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

Illinois Ryan White Monthly Household Income Statement

Authorization to Release Health Information and Privacy Practice 

SIHCC Grievance Policy and Procedure Form

If you are in need of rent, security deposit or utility assistance, please contact your case manager to see if you qualify and if funding is available.  

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