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Form 888 online PA: What You Should Know

Put your state of medical emergency on line B, line 3. Under “Personal information”, type in your PA access code. Put the address of your prescription and/or mental health services clinic on line D. Add the address of your insurance carrier on line E. You may also enter your home phone number on line F. Put your credit card information on line G. Pay through the link on the website. NOTE: No medical ID is required for your PACE card. Please do not be worried if you have your photo on the back of your card or on a necklace. We do not ask for them on PACE cards unless you are applying by mail. You do need to submit the proof of medical condition/receipts for mental health & PA. Criminal background, which is usually your state or federal medical and/or criminal history. Please click on the image to get the PDF version of these forms. Pennsylvania PACE card: PA access code: Pennsylvania PACE card: PA access code: Pennsylvania PACE card: Pennsylvania PACE card: Pennsylvania PACE card: PA access code: PA access code: Pennsylvania PACE card: Pennsylvania PACE card: Please click on the image to get the PDF version of these forms.

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