Patient Financial Assistance Program
The Hemophilia Foundation of Maryland (HFM) Financial Assistance Program is part of HFM's Continuing effort to improve the quality of life for individuals and families affected by bleeding disorders. This program provides funds to eligible individuals and families who need assistance with:
- Expenses incurred in the care and treatment of a bleeding disorder, and/or
- Basic living expenses emergencies.
- You must be a resident of Maryland;
- You must be the parent or caregiver of a minor child who lives in your home and who has a diagnosis of a bleeding disorder; OR be an individual with a diagnosis of a bleeding disorder.
- You must have requested assistance from TWO (2) other agencies before applying to HFM, and provide contact information for those agencies and the status of your requests.
- You must complete ALL sections of the application thoroughly and accurately. (If a question does not apply, it should be marked "not applicable or N/A".
- Applications forms are available by calling the HFM office at 410.661.2307 or by downloading the application above.
- Completed applications and a copy of the bill must be submitted by mail, fax or email to: Hemophilia Foundation of MD, 13 Class Court, Parkville, MD 21234; Fax: 410.661.2308; Email: [email protected]
- The Johns Hopkins Hemophilia Treatment Center Social Worker will review all applications for completeness, check references and consider the date the funds are needed in order the determine the urgency of the request.
- Incomplete applications will be returned to the applicant with an explanation of why it was returned and a description of the information still required.
- Complete applications will be sent to the HFM Patient Services Committee for review.
- If the application is approved, HFM staff will notify the applicant, and a check will be mailed to the creditor identified on the application.
- If the application is rejected, HFM staff will notify the applicant with an explanation.
- HFM staff will update its Financial Assistance Program records and add the applicant to the HFM database for future communications.
- Applicants and information pertaining to funding requests are considered confidential.
- Information from HFM Financial Assistance Applications may be compiled for statistical purposes, and for compliance with local, state, federal and affilate organization requirements. However, any publication of this dates will be in aggregate form only, and will not include names or any other information that could be used to identify individual applicants or recipients.
- No personal information will be used or disclosed for any purpose other than that for which it was collected. At no time will personal information be shared with any individual, company or organization outside of Hemophilia Foundation of Maryland.