Step 1: Check Eligibility
- Have at least one member in the household with a diagnosed bleeding disorder
- Have at least one member with an active inhibitor: a measurable titer and/or shortened half-life
- Have documentation of medical recommendation stating reason for request, how it will support inhibitor treatment, and confirms diagnosed bleeding disorder and active inhibitor
- Travel arrangements must be made at least 30 days prior to the requested medical visit
Step 2: Obtain Written Documentation
- Must be from a healthcare provider (doctor, nurse, physical therapist, or hospital social worker)
- Confirmed diagnosed bleeding disorder and active inhibitor
- States the reason for the request and how it will support the patient’s inhibitor treatment or education
- Can be in the form of a letter, medical visit notes, or this medical verification form
- Upload document(s) in the referral form or email us.
Step 3: Complete Form
- Complete either the tutoring/educational supplies form or the medical travel reimbursement form
- Upload document in the referral form or email us.
Step 4: 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
Step 5: HFA Processes the Application
- A Helping Hands staff member will contact the applicant for a phone interview, usually 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.