Healthy Living Items Assistance

Step 1: Check Eligibility

• Have at least one member in the household with a diagnosed bleeding disorder
• Patient must live in a US state or territory
• Have medical recommendation for approved item
• Demonstrate the inability to afford the item without assistance

Step 2: Obtain Written Documentation

• Must be from a healthcare provider (doctor, nurse, physical therapist, or hospital social worker)
• Confirms diagnosed bleeding disorder
• States specific item(s) needed and how the item(s) will support the bleeding disorder
• Can be in the form of a letter, medical visit notes, or this medical verification form
• Upload document(s) in the referral form

Step 3: Complete the Online Referral Form

• Can be completed by the applicant or a professional representative in the bleeding disorder community.
• If the need is time-sensitive, please specify why and when the item is needed
• Provide item details for purchase (link for online purchase, order form, size, measurements, etc.) or detailed receipt for reimbursement in referral form

Step 4: HFA Processes the Application

A Helping Hands staff member will contact the applicant for a phone interview within 30 days of receiving the application. The interview takes about 10 minutes and reviews applicant’s monthly household income, household information, and next steps.

A referral indicates permission to contact both the applicant and the referrer. We will be in touch with the referrer or a local professional about any safety issues raised in our phone interview.