Please note that all funds for November have been exhausted and all requests submitted for the month will be not reviewed by the committee until Early December.
Before submitting a request for patient/participant support through AltaMed GIVES’ Immediate Needs Fund, please review the available resources below. Note: resources below are for Managed Care patients only. If your request is for a non-managed care patient, please proceed to Section B of the form.
Services and support are available for our managed care patients and can be accessed by sending a referral to the Medical Management Department. Below are examples of resources available through AltaMed Net
- Community Based Adult Services
- Home Environment
- Low Income Utility Resources
- In Home Supportive Services (IHSS)
- Disability Resources
- Foundation Referrals
- Low Income Eye Glasses Resources
- Long-Term Services and Support (LTSS) / Multi-Purpose Senior Services Program (MSSP)
- Substance Abuse
- Food Resources
- Housing Resources
- Low Income Funeral Benefits Resources
- Mental Health
- SSI Benefits Information
You will receive a response after request is reviewed by Employee Giving Committee, no earlier than a week after submission. If you have any questions please email [email protected]. Thank you for being an advocate for the community we serve!
General Eligibility for Patient/Participant – The Development team will remove any identifying patient information before sending out for vote.
- Name of Recommender (Active AltaMed Employee)
- Patient/Participant Age Range
- Marriage Status (if applicable)
- Number of people in household
- Number of dependents
- Number of Children under 18
- Household income (No proof necessary)
- Number of years as an AltaMed patient
- Verification of need (if applicable)
- Cannot be an AltaMed employee
- Cannot be an immediate family member of an AltaMed employee (including domestic partner, aunt, uncle, cousin, niece, nephew, and grandparents)
Assist patients/participants who do not have access to basic necessities that affect their health and well-being.
- Food & Related items
- Specialist Appointment Co-Pay
- Medication/Rx Co-Pay
- Transportation to Specialist Appointment
- Seasonal clothing (jackets, shoes)
- Home Essentials
Dollar amount provided
- $1,000 per month – Dollar amount is for all sites
- Patient/ Participant can receive amounts of $25, $50, $100, $250 or other