Get 2014 Application For Patient Financial Assistance - Team Continuum - Teamcontinuum

Completing the 2014 Application For Patient Financial Assistance - Team Continuum - Teamcontinuum can be an important step in obtaining financial support during treatment. This guide is designed to help users navigate the application process efficiently and ensure that all necessary information is included.

Follow the steps to successfully complete the application.

1. Press the ‘Get Form’ button to access the application and open it for editing.
2. Section 1 requires information from a licensed social worker. Ensure this section includes the social worker's name, title, organization, contact information, and their certification of the application.
3. In Section 2, the patient must provide their personal details. This includes their last and first name, contact information, age, and details regarding previous assistance from Team Continuum.
4. Section 3 focuses on financial information. The patient must submit evidence of their family expenses and assets, including two months of bank statements and documentation of income. Be thorough to ensure this section is complete.
5. In Section 4, indicate whether the patient has health insurance and provide details about the type of insurance. This includes checking relevant boxes and confirming if prescription drugs are covered.
6. Section 5 outlines the assistance needed. The patient must specify what assistance they are requesting along with any costs, and attach copies of relevant bills.
7. Section 6 must be completed by the patient's oncology doctor or nurse, including the date of diagnosis, primary cancer diagnosis, and any active treatment details.
8. Complete Section 7 as a checklist to ensure all necessary information and documentation are included. Mark each requirement to confirm they are met.
9. In Section 8, the patient or guardian must provide a signature affirming the accuracy of the information provided and their understanding of the process.
10. Once completed, ensure that all sections and documents are included in one package. Submit your application by mail, fax, or email without sending multiple transmissions.

Start filling out your application for financial assistance online today!