Lyme tap form 2014-2026

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The Lyme Test Access Program (Lyme-TAP) is a nationwide initiative by the Ferndale Foundation and Rotary Club of Southwest Eureka that provides financial assistance for initial Lyme-related lab tests to patients in genuine financial need. Eligible applicants can receive reimbursement for up to 75% of their out-of-pocket testing costs from approved laboratories. The program prioritizes children under 18 and requires proof of financial hardship, including tax returns and lab receipts. Applications are processed on a first-come, first-served basis, with funds limited.

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Click ‘Get Form’ to open the Lyme Tap Form 2014 in the editor.
Begin by filling out your personal information, including your name, address, and contact details. Ensure all fields are completed clearly.
Provide your healthcare provider's information. This includes their name, address, and contact number. Make sure this is accurate as it will be verified.
In the Diagnostic Test Information section, list the tests performed and their costs. Indicate if you have been tested previously.
Complete the Statement of Financial Need section by selecting the appropriate options regarding your income and circumstances. Attach necessary documents like your 1040 Federal tax return and lab receipts.
Have your healthcare provider complete their certification section, confirming medical necessity and financial hardship.
Review all entries for accuracy before submitting. You can submit via fax, email, or mail as per the instructions provided.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (74 Votes)
2014	4 Satisfied (27 Votes)
2012	4.3 Satisfied (140 Votes)

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What is the most accurate test for Lyme disease?

Abstract. Background: The Rule of 7s classifies children as low-risk for Lyme meningitis with the absence of the following: 7 days of headache, any cranial neuritis or 70% cerebrospinal fluid mononuclear cells.

What is the rule of 7 for Lyme disease?

Under Diagnostic Code 6319, active Lyme disease will be assigned a 100 percent disability rating. If inactive, residuals will be rated under the appropriate system.

What is the Lyme test access program?

The Lyme Test Access Program (Lyme-TAP) is a nationwide (US-only) patient assistance program to provide assistance for initial Lyme-related lab tests to patients who demonstrate financial need.

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