School Telehealth Registration

Welcome to SICHC’s Telehealth Student Online Registration for Orange County Community Schools

Southern Indiana Community Health Care is partnering with Orange Co. Schools to provide students (and staff) the opportunity to be seen by a licensed healthcare provider without having to leave school. 

Healthier Kids Make Better Students



Each online registrant will need to fill out their appropriate forms listed below and submit them individually to SICHC for their respective child(ren); and/or students over 18yrs old, and staff. Scrolling down you will find more information about the program as well as more information about the forms.

What You Will Need

  • Proof of Insurance (applicable and if available) – Provide clear photos of front and back of insurance or Medicare cards via upload (below).
  • Proof of Identification – Provide clear photos of Drivers License, Passport, Green Card, etc. documents/cards via upload (below)
  • Student(s) (and Parent) – Social Security number, Contact information, plus emergency contact information
  • Student(s) health history – A list of medications, allergies, list of healthcare providers, family health history, immunization history
  • Pharmacy Information

Advantages of Using the Telehealth Clinic

  • See the provider at school – the virtual clinic appointment occurs during school hours
  • Your child doesn’t miss class as much – the visits are quicker because your child gets medical attention without leaving school.
  • You don’t miss work! – This is especially helpful for routine wellness, and chronic medication visits as you avoid travel time and the days off it takes to get your children their regular health care.
  • Fewer ER visits – This means greater cost savings and less out of pocket expenses
  • Prescriptions can be sent to the pharmacy and be ready for pharmacy pick up when you are available.
  • Fees are billed directly to your insurance provider – It is billed the same as an in-person office visit at your doctor
  • Local providers are doing this medical care – SICHC has been providing care to the community for almost 50 years and is a trusted partner in many families’ health care. Our offices in Paoli, West Baden, English and Marengo provide for the full scope of services.

Description of Services

SICHC will provide general primary care services that value the unique needs of each person including but not limited to:

  • Diagnosis and treatment for acute illnesses and minor injuries such as strep throat, ear infections, rash, and influenza
  • Asthma management
  • ADHD follow up visits
  • Sports medicine
  • Limited laboratory testing
  • Behavioral health services
  • Teacher health care needs

The Telehealth Clinic  

The Telehealth Clinic visits are medical, or counseling visits conducted privately inside the school nurse’s office.

Hours: Monday – Friday 9am – 4:20pm  |  Closed during school holidays
Location(s):  Serving all Orange County schools
Appointment:  Appointments will be on an as needed basis requested by the schools nurse

How does it work?

The school nurse will contact you if your child has become ill or may benefit from being seen by a counselor during the school day.  At the time of that phone call, you may choose to take your child from school or to be seen by the school-based telehealth provider. A parent will always need to give permission for the student to be seen and may also be present for the visit in person or by phone or virtual connection. If permission is given, the student will have a telehealth visit with an “on-call” SICHC provider.

Medical Visit

The physician or nurse practitioner starts with an on-screen conversation to talk about symptoms with the nurse, child and family member. Then as the nurse uses special equipment to examine the child, the provider can view a live feed of what the nurse on-site is seeing. This gives a close and clear look at the child’s ears, eyes, throat, and skin. The addition of a virtual stethoscope permits the provider to listen to heart, lung, and abdominal sounds. The camera and audio tools make the visit much more valuable than a simple on-screen visit.

Behavioral or Mental Health Visit

Good health comes from the whole health of mind, body, and spirit. SICHC is dedicated to improving the mental and emotional well-being of Orange County students with integrated services and collaboration with school counselors and social workers. In addition, your child may see one of SICHC’s licensed clinical social workers on staff or one of our behavioral health coaches who can support students during social or emotional challenges.


The SICHC provider who sees your child will provide a written summary of their findings so that you have a clear understanding of the diagnosis and treatment. The visit summary will also be sent to the patient’s PCP. 


The Telehealth Clinic has some limitations because it is not providing a live, in-person physical examination. Some health conditions are not suitable for telehealth and must be treated by an in-person provider. SICHC healthcare providers will do their best to provide reasonable medical advice and treatment based on the patient’s telehealth visit.

Insurance, Assistance, or Out of Pocket

Services are not billed at time of appointment. They will be processed via:

  • Insurance – Services provided at the school-based telehealth clinic will be billed to your insurance company. Co-pays or normal office visit fees may apply depending on insurance coverage. If you do not have insurance, please contact SICHC insurance navigator Jessica Cooper (812) 723-7130 or Lincoln Hills Development Corporation at (812) 338-2350 to assist you with obtaining insurance.  
  • Community Health Assistance Program (CHAP) – To see if you’re eligible (whether you have insurance or not); please complete Community Health Assistance Program application (below) for consideration of a sliding fee discount.
  • Out of Pocket – You will be mailed a bill for services, which can be paid via credit card or check.
  • No student will be denied services because of the inability to pay.

HIPAA Compliance Patient Consent Form 

Our notice of privacy practices provides information about how we may use or disclose protected health information. The notice contains a patient’s rights section describing your right under the law. You ascertain that by your signature that you have reviewed our notice before signing this. You have the right to restrict how your protected health information is used and disclosed for treatment, payment, or healthcare operations. We are not required to agree with the restriction, but if we do, we shall honor this agreement. The HIPAA (Health Insurance Portability and Accountability Act of 1996) law allows for the use of the information for treatment, payment, or healthcare operations.

NOTE: This is a required form submission (for each student, if more than one). If you have already registered for the telehealth clinic from previous school years, regardless of if you’ve already signed one of these in the past; SICHC will still need a new HIPAA Form on file for each school year. 



School Telehealth Consent Form 

Consent for School-Based Telehealth Clinic – Before anyone is seen at the School-Based Telehealth Clinic (“Telehealth Clinic”), this consent form must reviewed and filled out, signed and on file, and proper documentation of insurance obtained.

NOTE: This is a required form submission (for each student, if more than one). If you have already registered for the telehealth clinic from previous school years, regardless of if you’ve already signed one of these in the past; SICHC will still need a new Telehealth Consent Form on file for each school year. 

School Telehealth Consent Form


New Patient (Age 18 and Older) Telehealth Enrollment Form 

Please complete all sections of this form if you are age 18 or older and are not an established patient with SICHC.

NOTE: Depending upon age, this or the other New Patient Telehealth Enrollment form, is a required form submission unless existing SICHC patient.

New Patient (Age 18 and Older) Telehealth Enrollment Form


New Pediatric Patient (Under Age 18) Telehealth Enrollment Form 

Please complete all sections of this form if your child is under age 18 and is not an established patient with SICHC.

NOTE: Depending upon age, this or the other New Patient Telehealth Enrollment form, is a required form submission unless existing SICHC patient. 

New Pediatric Patient (Under Age 18) Telehealth Enrollment Form


Community Health Assistance Program (CHAP) Form 

The following application is optional. 

Since 1975, Southern Indiana Community Health Care has offered financial assistance to anyone who is having difficulty paying for healthcare, and as a federally qualified community health center, we will not deny services to anyone based on their ability to pay.

SICHC’s Community Health Assistance Program (CHAP) offers a sliding fee discount for qualifying patients whose income and family size is below 200% of the federal poverty guidelines. 

Click on the application button and learn more about discount guidelines and benefits, and if you would like to fill out the application and submit it, a representative from SICHC will contact you to help you submit additional needed forms.

Community Health Assistance Program (CHAP) Form


Proof of Identity & Insurance Form 

Proof of Identity and Insurance (if available) is needed to complete a successful application process.

Provide clear photos (or scans) of parental identity (for minors under 18 application), and Patient identity (over 18) by submitting a valid drivers license (front), passport (ID page), green card (front). Also include a proof of insurance (if available) (front and back of card). 

NOTE: Proof of Identity & Insurance (if available) is a required form submission. 

Proof of Identity & Insurance

Submitting Printable Forms

This set of forms are downloadable .pdf files. Once downloaded to your computer and printed, fill out and submit via the instructions on the Proof of Identity and Insurance Form.

Telehealth Consent Form
Telehealth Enrollment Form (New Patient) – Pediatric (under 18yrs of Age)
Telehealth Enrollment Form (New Patient) – Adult (over 18yrs of Age)
CHAP Assistance Form
Proof of Identity and Insurance Form


More About the Program

Read more about the program here:

Questions? Please contact SICHC program support staff:  Lindsey Gardner – (812) 203-2219  |


We care about your privacy.
Please check out our Privacy page, Notice of Privacy Practices, and Health Information Privacy Policy (HIPPA) pages for details.

© 2024 Southern Indiana Community Health Care.   PRIVACY

Social Media