Get How Can I Apply To Team Continuum For Financial Support Form

This guide provides a comprehensive overview of how to complete the How Can I Apply To Team Continuum For Financial Support Form. By following the steps outlined below, you can ensure your application is filled out accurately and completely to facilitate consideration for financial support.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1: Patient Information. Fill in your last name, first name, address, city/state/zip, phone numbers, and email. Indicate your gender and age. If you are a minor, include the name of your parent or guardian. Respond to the questions regarding previous applications and assistance received.
3. Move to Section 2: Financial Information. Provide a list of your monthly family expenses and total them. Attach required documentation, including copies of current bills and bank statements. Avoid submitting tax returns. Also declare your family assets with corresponding amounts.
4. Next, in Section 3: Health Insurance Information, indicate whether you have health insurance and specify the type. Answer questions about prescription drug coverage and medical bill inclusion.
5. Proceed to Section 4: Assistance Needed. List the exact needs for which you are requesting assistance, including costs and required documentation. Be sure to attach any necessary bills.
6. Complete Section 5 with your signature, certifying the accuracy of the information provided. Include your printed name and your relationship to the person applying for assistance.
7. Section 6 must be filled out by your social worker. Ensure they complete this section fully, including their contact information.
8. Finally, Section 7 is for completion by your Oncology MD or Oncology RN. They must provide diagnosis details and treatment information.
9. After completing all sections and ensuring the form is accurate with all required attachments, you can save your changes, download, print, or share the form as needed.

Complete your application online to take the next step in securing financial support from Team Continuum.