Get Jjpaf Application

The Johnson & Johnson Patient Assistance Program Application (Jjpaf Application) is a critical resource for individuals seeking financial assistance for prescribed medications. This guide will help you navigate through the application process online with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully fill out the Jjpaf Application online.

1. Press the ‘Get Form’ button to access the Jjpaf Application and open it in your preferred editor.
2. Begin by filling out pages 1 and 2 of the application with your personal information, including name, telephone, email, social security number, date of birth, and address. Ensure that all fields are completed accurately.
3. Provide your financial information, which includes attaching a copy of your most recent 1040 or 1040EZ federal tax return. If you do not file federal taxes, indicate that in the designated option.
4. Complete the healthcare insurance information section by selecting all applicable options. If you have insurance, provide the necessary details such as policy numbers and coverage status.
5. Sign and date the Patient Declaration and Authorization to Share Information on page 2. This step confirms the accuracy of the information you provided and allows information sharing as necessary.
6. Submit your application by either mailing or faxing your completed form with all required documentation to the Johnson & Johnson Patient Assistance Foundation, Inc. Refer to the provided contact information for submission.
7. Keep a copy of the completed form and any submitted documents for your records to ensure you have proof of your application.
8. If applicable, ask your healthcare professional to complete pages 3-4 of the application and sign page 4. Ensure they provide all necessary information regarding your prescribed medication.
9. After reviewing your application and receiving any necessary signatures, save changes, download, print, or share the form as needed.

Take the first step in securing your prescription assistance by completing the Jjpaf Application online today.