Electronic request on 6/17/2017
Case 1: Pt is a four y/o female followed in the Complex Care Program due to a history of Dravet syndrome, periventricular leukomalacia (PVL), seizure disorder, gj-tube dependence, visual deficits, short stature, osteopenia, and developmental delay. The mother is a single mother to two children, both of whom have complex medical needs. The patient's 11 y/o brother is having an emergency spinal surgery today (6/16/17) after breaking a rod in his back this week. He also has been diagnosed with Autism Spectrum D/O. The family has limited income, and the children require frequent outpatient clinic appointments along with some hospitalizations (frequent travel to/from ACH).
We are asking for financial assistance in the amount of $850, if possible, to cover the cost of the repairs and tires. Request approved.
Total asked: $850 APPROVED
