To apply for financial assistance, the applicant must have:
- A completed Patient Assistance Program Application
- A confirmed PFIC diagnosis, confirmed by physician or casework on
- hospital/clinic letterhead; or Medical Eligibility form completed by a physician (**May substitute this requirement by providing public social media page or CaringBridge page sharing information about PFIC diagnosis and/or journey at the decision and discretion of the PFIC Executive Director**)
- A signed Waiver (See Program “Terms and Conditions”)
- An explanation of specific financial need
Additional Information Regarding Application Process
- A detailed description of need is highly recommended, as it will be used to determine level of need among applicants
- You may apply as many times as needed throughout the year. However, a family will be awarded assistance a maximum of one (1) time per calendar year.
- The PFIC Network will ONLY make payments directly to third party service
- providers, not to the family directly. (For example: A request is made for
- assistance for electric bill. If approved, PFIC will make payment directly to
- electric company).
- The third-party bill(s) MUST be provided, if approved, before any assistance will
- be provided.
- Assistance cannot be used for emergency services, including utility cut off notices.
- Final approval of financial assistance is determined on a case by case basis by the PFIC Network Board of Directors.
**If applicant is awarded scholarship, documentation of the requested bill to be paid must be
provided to PFIC Network before payment will be awarded.**