Get Project Angel Heart Application For Services 2020-2025

Filling out the Project Angel Heart Application For Services online is an important step for those in need of medically tailored meals. This guide provides a clear and supportive walkthrough for completing the application effectively.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form. This will allow you to open it for online completion.
2. Begin with the applicant information section. Fill in your first name, last name, middle initial, physical address, city, zip code, county, and mailing address if it differs from your physical address. Provide a contact phone number and your primary language, along with your date of birth, height in feet and inches, and weight in pounds or kilograms.
3. In the primary diagnosis section, check all applicable boxes related to your health conditions, including HIV status, cancer type and stage, and any treatment specifics. Specify any other illnesses if applicable.
4. Proceed to the other medical conditions section. Check any medical issues you have exhibited in the past 30 days. This may include conditions like nausea, unintentional weight loss, or shortness of breath.
5. Complete the mobility section by checking any relevant boxes concerning your mobility status, such as being bedbound or needing assistance.
6. In the hearing and vision section, indicate any relevant conditions like partial blindness or hearing impairment.
7. Fill in the gender section by selecting all options that apply to you.
8. Complete the ability and resources section, checking off any assistance you may require regarding meal shopping and preparation.
9. Describe your living situation and military status by selecting all applicable options.
10. Specify any dietary requirements due to medical necessity or religious preference and note any food allergies.
11. Choose your preferred delivery options, such as frozen or hot meals, according to your eligibility.
12. In the race and ethnicity section, select one option from each column as requested.
13. Provide information about your income and insurance status. This data is for reporting purposes only and does not affect your service eligibility.
14. Complete the contact information section to indicate if you are the primary contact and provide details for other relevant contacts.
15. Obtain the health care provider authorization by having your healthcare provider complete and sign this section of the application.
16. Sign the client release of information section to authorize the exchange of necessary health information.
17. Once all sections are completed, you can save your changes, download, print, or share the form as needed.

Start filling out your application online today to ensure you receive the essential services you qualify for.