Immediate Needs Fund – Request Form

The Employee Giving Committee accepts requests on Mondays and Wednesdays. Once an employee submits a request, they will receive a response within 72 hours of the request being reviewed.

Program guidelines

To assist patients/participants who do not have access to basic necessities that affect their health and well-being.
Those who do not qualify for this program:
  • AltaMed employees including: contractors, per diem, interns and/or AltaMed fellows
  • Family members of an AltaMed employee (including domestic partner, children, siblings, aunts, uncles, cousins, nieces, nephews, and/or grandparents)

Examples of eligible needs are:

  • Food & related items
  • Specialist appointment co-pay
  • Medication/Rx co-pay
  • Transportation to specialist appointment
  • Home essentials

Is this a Managed Care patient?

YES NO

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:

AltaMed Net Instruction
• Community Based Adult Services
• Home Environment
• Low Income Utility Resources
• In Home Supportive Services (IHSS)
• Transportation
• 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