Patient Aid Application

CARE was established to provide assistance to our Las Cruces and Dona Ana County community. CARE especially helps cancer patients, children and adults,  who have recently been diagnosed with cancer and are receiving treatment.  Through the Care and Support Program, the focus is to provide financial assistance to cancer patients and their families to help them cope with their cancer treatment by assisting them with non-medical expenses/basic living needs expenses while they begin active treatment for any type of cancer (chemotherapy, radiation, surgery, clinical trial or bone marrow/stem cell transplant).  This program assists patients and their families and helps relieve stress as they go through treatment so  they may concentrate on their treatment and recovery.  Treatment  typically may consist of one month to up to 12 months of active treatment.  This is the active period our Care and Support Program may assist cancer patients and their families with financial assistance.  Applications are valid for up to one calendar year, January through December, of the year of the application’s submission. If a patient is receiving treatment beyond the current submission year, the patient will need to submit a new application in the new calendar year if he/she is still in active treatment.  Thus, you may be eligible for financial assistance within a two year period, which represents the duration you may be eligible to receive financial assistance from CARE:  2 year application cycles, which is a 2 year maximum limit.  This program may also provide emergency funeral expense assistance to CARE clients. This financial assistance is based on eligibility and funds availability.  Please review “Patient Services”  for more information.

All financial assistance provided by CARE is disbursed to third parties through our fiscal sponsor, Community Action Agency of Southern New Mexico.  Financial assistance disbursements are made once per week.

Dona Ana County cancer patients who are receiving treatment for any type of cancer and need financial assistance may apply to CARE by completing our Application for Patient Assistance.  Please click and download the application in PDF format below:

CARE – APPLICATION FOR PATIENT ASSISTANCE

Pages 2 and 3 are the patient’s information portion of the application to complete.  Page 4 is a check off list and signature page.  Page 5 is the patient’s authorization page.  Page 6 must be completed and signed (original signature/no stamps) by the patient’s oncology physician.  The completed application with requested documentation must be returned to CARE.  Incomplete applications will not be considered.  Once the application is complete and requested documents have been compiled, please contact CARE at 575-649-0598 to set up an appointment for consideration to the program.

Patients who are approved for financial assistance through CARE will complete  the Client Request for Financial Assistance form each time that they are requesting financial assistance to CARE based on the policy provided to the patient. If you are in active treatment and are eligible to receive assistance when you submit your application, please complete the form now.  Please download the form below:

CLIENT REQUEST FOR FINANCIAL ASSISTANCE FORM

Cancer Aid Resource & Education, Inc.
118 S. Water St.
Las Cruces, NM  88001

Should you have any questions, please call 575-649-0598.

Leave a Reply

Your email address will not be published. Required fields are marked *