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.