Hospital Professional: Extended Hospital Stay Financial Assistance Referral
Ends on
Guidelines
This section must be completed by a social worker, nurse, or doctor. All information will be verified by the patient. We do this as a requirement of our 501c3 nonprofit status.
Eligibility for our Extended Hospital Stay Fund Program is as follows:
- Any child or adult diagnosed with cystic fibrosis who has experienced a 14 consecutive day hospital stay within the last calendar year. *Due to COVID, we have expanded this to include a home tune up that includes at least 14 consecutive days on IV medication or if a patient is discharged from the hospital to complete a 14 day IV medication round at home.
- At this time, we are only able to assist patients with rent or mortgage payments due to a decline in donations and an increase in need in our community.
- In order to review the request for financial assistance, a hospital professional (Doctor, Nurse or Social Worker) must complete and submit this referral form.
* Financial assistance is typically a one-time payment for approved applicants paid to a third-party vendor on the applicant’s behalf.