Helping Hands Referral Form

HFA鈥檚 Helping Hands Emergency Assistance is designed to establish a rapid, non-invasive source of relief for emergency situations or urgent needs to persons who are affected by diagnosed bleeding disorders. Each year, Helping Hands aids hundreds of families with emergency/urgent funding to assist in crisis situations such as housing, transportation, and utility bills. Helping Hands cannot cover any medical expenses including medical bills, dental bills, insurance premiums, co-payments, deductibles, medications, factor, etc. Please visit HFA鈥檚 Navigating Patient Assistance Programs chart to find other financial resources.

How It Works:

Applicants must meet the eligibility requirements to be considered for the Helping Hands program.

Eligibility Requirements:

  • Individuals with a diagnosed bleeding disorder and/or anybody who lives in the same home of the person affected by a diagnosed bleeding disorder.
  • The applicant must not have applied within the last year or 365 days.
  • The applicant is currently experiencing or have recently experienced hardship directly affected by a bleeding disorder related event.
  • The applicant must have a referral submitted to the Helping Hands Program Coordinator by an Eligible Referrer. An Eligible Referrer includes:
    • Physician, nurse, or social worker from a Hemophilia Treatment Center
    • Private physician
    • Representative from a national, regional, state, or local bleeding disorder organization
    • Homecare representative of the applicant

*Funding will be considered for assistance to meet emergency or urgent needs.


  1. The applicant must have a referral submitted to the Helping Hands Program Coordinator by an eligible referrer. Please note the referrer will need to know the following information about the applicant in order to submit a complete referral form.
    • Applicant鈥檚 contact information
    • Description of need
    • Household members鈥 names and their relation to the bleeding disorder community
  2. Referral form is received by the Helping Hands Program Coordinator and applicant is contacted within five business days to complete a phone interview. During the interview, the Applicant will be asked a standard set of questions about monthly household income, expenses, and the situation causing the current need.
  3. The Helping Hands Program Coordinator submits the application to the Helping Hands Committee. All funding decisions are made by the committee after carefully reviewing the entire situation of the applicant and determining if assistance from Helping Hands will be able to effectively help the applicant in need. Applications are submitted to the committee anonymously.聽The applicant鈥檚 identity is not shared with the committee members.
  4. If approved, the applicant is required to submit a written statement of need along with proof of the emergency or urgent situation prior to payment.
  5. The process is generally completed within two weeks.

*Please contact HFA at 202-675-6984 or with any questions.


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