FAMILY ASSISTANCE PROGRAM APPLICATION
Are you a Cardiac Intervention Family (Pre-Surgery | Post-Surgery in patient?) Yellow Brick Road: The Holden Flynn Foundation can provide financial assistance through the Tin Man Fund for Cardiac Intervention Families. Reimbursement for medical bills, travel costs, and cost of living is available up to $500. Yellow Brick Road is honored to be able to review your Family Assistance Application and learn more about your family’s story. Yellow Brick Road serves the Greater Central Florida Congenital Heart Disease community and the three main children’s hospitals: Arnold Palmer Hospital for Children, The Florida Hospital for Children, and Nemours Children’s Hospital
DISCLAIMER
By completing and submitting this application, I affirm that I do not have personal or private interest in The Holden Flynn Foundation, and I am not a family member or business associate of its managers, officers, or directors. The undersigned (and on behalf of the patient authorizes the Yellow Brick Road: The Holden Flynn Foundation, Inc. (“Foundation”) to use the information in this application to process the grant request and determine the availability of Foundation and non-Foundation programs and services for the benefit of the patient and family. This consent allows and released the Foundation from HIPAA and related medical and non-medical privacy related disclosure requirements.