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Primary Care Physician (PCP)
Mansour Al Shobaki
Abdul Durrani
Farkhunda Mazheruddin
Farkhunda Mazheruddin
Ali Mohiuddin
Syed Quadri
Sitara Sharif
Badar Zaheer
Zareena Abbas
Farooq Ahmed
Ayoade Akere
Ruhi Askari
Care & Care Medical Center
GEFCC/ Seneca Health Ctr
GEFCC/ Summit Health Ctr
GEFCC/ McHenry Health Ctr
GEFCC/ Streamwood Health Ctr
GEFCC/ Creekside Health Ctr
GEFCC/ Lake Health Ctr
Hamdard Ctr Clinic
Farzana Hosain
Shaheen Humayun
Ahmed Hussain
IFN Clinic at Islamic Foundation North
Gowhar Khan
Naveed Mallick
Abdul Qadir
Syed Saaduddin
Nasreen Shah
Muhammad Shahzad
Asrar Sheikh
Zainulabuddin Syed
Sabiha Thaseen
Sabiha Thaseen
Mohammad Toor
Syed Warsi
SAMS Free Specialty Clinic
Alia Siddiqi
Thana Tarsha
Mohammed Adil
Syed F. Hussaini
Waheeda Iqbal
Sher Ahsan Niazi
Abdelraouf Oubaid
Maaz Mohiuddin
Maaz Mohiuddin
Maaz Mohiuddin
Maaz Mohiuddin
Maaz Mohiuddin
Ayesha Siddiqui
M. Tarek Alahdab
M. Tarek Alahdab
Muhammad Ali
Safdar Ali
SAMS Free Specialty Clinic
Mohammad Toor
Mohammad Toor
SAMS Free Specialty Clinic
Muhammad Kudaimi
Murtaza Arain
Rabia Bhatti
Farheen Shah-Khan
Aamir Memon
Muhammad Zafar
Muhammad Zafar
Mohammad Al-Khudari
Mohammad Al-Khudari
Mohammad Al-Khudari
Mohammad Al-Khudari
Mohammad Ahsan
Hamdard Center Clinic
Hamdard Center Clinic
Kutub Uddin
SAMS Free Specialty Clinic
Gowhar Khan
Naveed Mallick
Azher Quader
Tariq T. Ahmed, DC.
Mated Masood, DC.
A.S. Jaber, DC.
Naveed Saeed, DC.
Naveed Saeed, DC.
Naveed Saeed, DC.
Naveed Saeed, DC.
Ilyas Ahmed
Parveen Ahmed
Parveen Ahmed
M. Adil Asim
Dental 360 USA
Firdaus Jafri
Mimi V. Johnson
Hammad Khan
Hidayathulla Khan
Hidayathulla Khan
M. Khan
M. Khan
Nida Marouf
Salmaan Poothawala
Salman Poothawala
Haroon Shah
Haroon Shah
Imaad Shaikh
Imaad Shaikh
Irving Park Dental
Khalilur Rahaman
Ann Kalladanthyil
Asif Khan
Fahad Khan
Hooman Keshavarzi
Royal Help Health Services Inc
Khalid Husain
Khalid Husain
Khalid Husain
Khalid Husain
Kareem A. Raheem
Any Lab Test Now
Central Clinical Labs
Citilabs Inc
Med Lab Inc
Medstar Lab
Northshore Clinical Labs
Oakcrest Medical Lab
Simple Labs
Unilab Inc
Imaging Centers of America
Marayah Diagnostic Imaging Center
Medical Imaging Center
Medquest Radiology Center
MedLife Diagnostic Center
Midwest Imaging & Diagnostic Ctr
Touhy Diagnostic
5 Star Healthcare Inc
Angel Touch Home Healthcare Inc
Proficient Home Healthcare Inc
Suhark Healthcare & Medical Equipment
Compassionate Care Pharmacy
1st Familt Pharmacy
Healthy Pharmacy
Naperville Pharmacy
Are you taking any medications?
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I DECLARE THAT I HAVE NO HEALTH INSURANCE COVERAGE FOR THE SERVICES BEING PROVIDED BY COMPASSIONATE CARE NETWORK, CCN.
I FURTHER DECLARE THAT MY BANK ACCOUNT AND COMBINED ASSETS INCLUDING PROPERTY, VEHICLES, CASH, AND JEWELRY ARE LESS THAN $5,000. MY ANNUAL INCOME IS NO MORE THAN $16,000. I ACKNOWLEDGE THAT ALL INFORMATION PROVIDED ABOVE IS ACCURATE TO THE BEST OF MY KNOWLEDGE.
ARE YOU ZAKAT ELIGIBLE
CHECK THIS BOX IF YOU AGREE THAT ALL STATEMENTS ARE TRUE, AND THAT YOU ACKNOWLEDGE THAT YOU ARE THE PERSON FOR WHOM THIS FORM IS FILLED OUT.
I DECLARE THAT I HAVE NO HEALTH INSURANCE COVERAGE FOR THE SERVICES BEING PRIVIDED BY CCN. I DECLARE THAT MY ANNUAL INCOME IS BELOW THE 400% FEDRAL POVERTY GUIDELINE THRESHOLD. I ACKNOWLEDGE THAT ALL INFORMATION PROVIDED ABOVE IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I AGREE TO PAY THE FEE OF $25.00 FOR EACH OFFICE VISIT TO THE CCN PHYSICIAN ASSIGNED TO ME. I ALSO UNDERSTAND THAT LAB AND X-RAY CHARGES WILL BE ADDITIONAL AND WILL BE PAYABLE BY ME TO THE PHYSICIAN'S OFFICE OR TO THE FACILITY DIRECTLY. IF I NEED SPECIALIST CONSULTATION AND SUCH A CONSULTANT IS NOT AVAILABLE WITHIN CCN THEN I WILL SEEK A CONSULTANT OUTSIDE THE NETWORK AND WILL BE WILLING TO PAY THE CONSULTANTS REGULAR FEE. IN CASE OF A MEDICAL EMERGENCY, I AGREE TO SEEK EMERGENCY ROOM CARE AT THE NEAREST HOSPITAL FACILITY AND WILL NOT HOLD ANY CCN PHYSICIAN LIABLE FOR MY CARE. I UNDERSTAND THAT PREGNANCY CARE IS NOT INCLUDED IN MY MEMBERSHIP. I AGREE TO PAY THE MINIMUM MEMBERSHIP FEE OF $60.00 FOR SIX MONTHS (INDIVIDUAL) or $90.00 FOR SIX MONTHS (FAMILY), TO JOIN THE NETWORK UNLESS OTHERWISE WAIVED. I AGREE TO ENROLL FOR SIX MONTHS (INITIAL) AND TWELVE MONTHS (SUBSEQUENT RENEWALS). MAKE PAYMENT TO COMPASSIONATE CARE NETWORK. MAILING ADDRESS: 6348 N. MILWAUKEE AVE., #215, CHICAGO, IL 60646.
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