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SOURCE Federal Register January 25 2016 https //aspe. hhs. gov/poverty-guidelines Adapted by The Leukemia Lymphoma Society s Patient Travel Assistance Program - Application Form The application must be completed in its entirety and must be signed by both the physician and the patient in the areas specified on the form below. Applicants must have a confirmed diagnosis of blood cancer and 3. Applicants may be insured or uninsured and Poverty Level FPL see below Program in the same fiscal year...
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Leukemia amp is an application for financial assistance available to individuals diagnosed with leukemia.
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Individuals who have been diagnosed with leukemia and are in need of financial assistance are required to file the application.
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Information such as personal details, medical diagnosis, treatment plan, financial status, and any additional supporting documents may need to be reported on the application.
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