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The IclaCares Critical Fund Program provides provides financial assistance to patients who meet eligibility guidelines and are in treatment to receive a bone marrow or cord blood transplant at a medical center based in the United States.
Priority for grants is given to patients who demonstrate the greatest financial need. The maximum grant allocation per patient is $500.
Please review the guidelines and enter your patient’s information on the Patient Registration Form below.
2024 Patient Registration Form
*PLEASE ENTER YOUR INFORMATION BELOW. WE WILL EMAIL A FINAL APPLICATION FOR SIGNATURE.
The final application must be completed and signed by the Patient (or their representative) and their Doctor, Nurse or Social Worker. Final submission requires three attachments a) signed patient registration, b) signed medical information, c) letter with details on hospital letterhead, plus all applicable receipts.
GENERAL GUIDELINES
To be eligible for the program, the following criteria must be met and (3) attachments submitted (+ applicable receipts):
- Patient must be a candidate for a bone marrow or cord blood transplant, receiving medical treatment at a certified medical center in the United States.
- Patient must have a household income that is at or below 400% of the current U.S. Federal Poverty Guidelines to be considered for financial support.
- Patient must be in active treatment with a scheduled date to receive a bone marrow transplant (or within 60 days post-transplant).
- Submit attachment a) PATIENT REGISTRATION, completed and signed by patient or family member.
- Submit attachment b) MEDICAL INFORMATION, completed by a Social Worker, Nurse or Doctor at the medical center.
- Submit attachment c) letter using hospital letterhead verifying diagnosis, need for a transplant, and details regarding the financial support requested (use of funds, timing, amount).
USE OF FUNDS
The maximum allowance per patient is $500, The IclaCares Critical Fund may be requested by patients and their families to cover costs associated with the following:
- Lodging while in treatment
- Transportation to receive treatment (including Gas/Parking/Taxi/Flight)
- Meal assistance during treatment (Groceries)
- HLA Compatibility testing (we utilize Labcorp for testing)
- Other (pending need and approval)
*The Icla da Silva Foundation reserves the right to deviate from these Guidelines when special circumstances arise on a case-by-case basis. Priority for grants is given to patients demonstrating the greatest financial need.
DISBURSEMENT OF FUNDS
Funds are dispersed directly to a specific vendor. Receipts or a bill must accompany all expense requests. There are some circumstances when funds may be provided to patients directly.