HFA’s Helping Hands Program provides a critical safety net for families facing financial hardship. The program provides financial support to families in the bleeding disorders community in their time of need through the following programs:
  • Emergency Assistance: supports families experiencing hardship with urgent funding for basic living expenses such as housing, car payments, utility bills, or funeral assistance
  • Items Assistance: assists with the cost of durable medical equipment and other medically recommended items
  • Inhibitor Support: supports families affected by inhibitors with the cost of medical transportation and tutoring/educational supplies
  • Disaster Relief: provides community members who are displaced or impacted by a natural disaster with immediate financial relief
Visit the website for eligibility requirements details:  http://www.hemophiliafed.org/helpinghands

Please contact HFA at helpinghands@hemophiliafed.org with questions.




Screening Questions

Do not proceed. The Relief Fund is for households experiencing a significant loss of income due to the COVID-19 pandemic. Please see HFA’s Helping Hands programs or our Patient Assistance Portal if the household is experiencing financial need unrelated to the impacts of COVID-19.

Do not proceed. The Relief Fund is for households who have lost income because of the COVID-19 pandemic, urgently need assistance paying a household bill, and are unable to do so without HFA assistance.

Please see HFA’s Helping Hands programs or our Patient Assistance Portal to find a better fit for the household's needs.

Local Support

Many local bleeding disorder organizations have funding to assist community members with unexpected costs associated with having a bleeding disorder and financial, emergency, and disaster assistance and items.

Please contact the local bleeding disorder organization and treatment center about assistance prior to submitting an application to HFA's Helping Hands program.




Referrer Information










We do not accept self-referrals for Emergency Assistance. The referral must be submitted by an Eligible Referrer:
  • Physician, nurse, or social worker from a Hemophilia Treatment Center
  • Private physician
  • Representative from a national, regional, state, or local bleeding disorder organization
  • Homecare representative of the applicant
  • Not a relative or employer of the applicant















Primary Applicant Information







Primary Applicant's Bleeding Disorder






Additional Household Member's Information

Family Member #2






Bleeding Disorder






Family Member #3






Bleeding Disorder






Family Member #4






Bleeding Disorder






Family Member #5






Bleeding Disorder






Family Member #6






Bleeding Disorder






Family Member #7






Bleeding Disorder






Family Member #8






Bleeding Disorder






Assistance Request

Note:  Helping Hands cannot cover any medical expenses including medical bills, dental bills, insurance premiums, co-payments, deductibles, medications, factor, etc. We do not cover legal bills or provide grocery or gas cards.
Note:  Our Disaster Relief Fund assists with needs such as temporary housing, replacement of necessary home items, household bills, and necessities like food and clothing. The amount and method of funding will be determined based on the applicant's need and disaster situation. Please summarize the needs below and we will be in touch with you soon.




$

Note:  Note: Helping Hands cannot cover any medical expenses including medical bills, dental bills, insurance premiums, co-payments, deductibles, medications, factor, etc. We do not cover legal bills or provide grocery or gas cards.


***  All medical identification jewelry products must be purchased directly by the applicant. HFA is unable to purchase these items on your behalf. Please purchase directly from your preferred medical ID product provider. Once the item has been purchased, you must submit receipt of item along with medical documentation of proof of bleeding disorder in order to be eligible for reimbursement. HFA can reimburse applicants up to $45 plus shippping for ID jewelry. We do not reimburse for alert services unless specifically recommended by a medical provider.



$
1) documentation from a healthcare provider confirming diagnosed bleeding disorder and recommendation for this request

AND

2) a receipt, invoice, or detailed instructions for ordering the exact item needed.

I understand that if I do not upload or email files to helpinghands@hemophiliafed.org now, there may be delays in processing this request.
Medical Verification
You may utilize this form or your own documentation.    [CLICK HERE FOR FORM]


You may submit the required documents by email: helpinghands@hemophiliafed.org





$
1) documentation from a healthcare provider confirming diagnosed inhibitor

AND

2) a receipt, invoice, or detailed instructions for completing the payment or reimbursement.

I understand that if I do not upload or email files to helpinghands@hemophiliafed.org now, there may be delays in processing this request.
Medical Verification
Must include medical proof of inhibitor

You may utilize this form or your own documentation.    [CLICK HERE FOR FORM]

Medical Travel
Please utilize this form for medical travel reimbursement.    [CLICK HERE FOR FORM]

Tutoring / Educational Supplies 
Please utilize this form for educational reimbursement.    [CLICK HERE FOR FORM]

You may submit the required documents by email: helpinghands@hemophiliafed.org