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American kidney fund application pdf

American kidney foundation patient profile worksheet 2025

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The document is a worksheet for the American Kidney Fund's Health Insurance Premium Program, designed to collect information from dialysis patients seeking financial assistance. It includes sections for dialysis center details, patient demographics, kidney diagnosis, treatment modalities, financial information, and consent for data sharing. The worksheet emphasizes confidentiality and outlines the process for submitting applications through AKF’s Grants Management System.

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Click ‘Get Form’ to open the American Kidney Foundation Patient Profile Worksheet in our platform.
Begin with Part 1: Dialysis Center Information. Fill in the facility name, number, corporate affiliation, and address details. Ensure you provide accurate contact information for the renal professional.
Move to Part 2: Patient Information. Enter your Social Security Number, date of birth, and personal details including mailing address and gender. This section is crucial for identifying your profile.
In Part 3: Additional Information, select your marital status and employment status. Provide details about your kidney diagnosis and treatment modality. This helps AKF understand your health background.
Proceed to Part 4: Request for Assistance. Answer questions regarding Medicare and Medicaid eligibility, as well as any state renal programs you may be part of.
Complete Part 5: Patient Financial Information by detailing household assets, monthly income, and expenses. This information is vital for assessing financial assistance needs.
Finally, sign in Part 6: Patient and Renal Professional Signature Confirmation to validate your application.

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What are the requirements for the AKF?

Small Enterprises with annual sales up to PKR 150M. Medium Enterprises with annual sales PKR 150M - PKR 800M. Age: 25-55 years. Active FBR tax filers with clean credit history. Residence and business located in Punjab. Valid CNIC and NTN. Must own / have rented the place of existing business.

Is American kidney Services a good charity?

About the American Kidney Fund AKF is one of the nations top-rated nonprofits, investing 97 cents of every donated dollar in programs, and it has received 24 consecutive 4-Star ratings from Charity Navigator as well as the Platinum Seal of Transparency from Candid, formerly known as GuideStar.

What if you cant afford dialysis?

American Kidney Fund. American Kidney Fund (AKF) is a nonprofit organization that provides charitable premium assistance to low-income dialysis patients. Its Health Insurance Premium Program (HIPP) gives long-term financial assistance to individuals so that theyre able to pay for health insurance.

What is the American Kidney Fund controversy?

Controversy. ing to the New York Times, the AKF has favored patients from clinics that contributed to the Kidney Fund, and discouraged other clinics from applying for assistance. Fresenius and DaVita provide nearly 80% of the AKFs funding.

What is the American Kidney Fund program?

The American Kidney Fund, Inc. (AKF) is a national, non-profit health organization dedicated to providing direct financial aid to dialysis patients, transplant recipients and donors to help cover the cost of treatment-related expenses.

american kidney fund patient profile worksheet pdf

American Kidney Fund American Kidney Fund debit card Housing grants for dialysis patients HIPP Program Department of Human Services HIPP program Income guidelines American kidney fund login American kidney Fund phone number health insurance premium program (hipp)

How to qualify for the American Kidney Fund?

You must show that you cannot afford your health coverage. This determination will be based upon review of the following: your household income may not exceed of 500% of the Federal Poverty Level (FPL) liquid assets (excluding retirement accounts) may not exceed $30,000.

What is the rating of the American Kidney Fund?

Rating Information This charitys score is 100%, earning it a Four-Star rating. If this organization aligns with your passions and values, you can give with confidence.

What is the income limit for the American Kidney Fund?

To qualify for AKF assistance, patients may not exceed a household pretax income of 500% of the Federal Poverty Level (FPL) and liquid assets (excluding retirement accounts) may not exceed $30,000. We selected 500% of FPL as this is the same or slightly higher threshold used by federal assistance programs.