Each application will be reviewed by committee members
Applications are reviewed weekly
We may contact the applicant’s healthcare providers for additional information if needed
Applicants will be notified once a decision is made
Money will be provided directly to the equipment vendor or service provider
We may utilize social media, e.g. Facebook, to inform our donors how funds are being allocated
Private information will not be revealed
APPLICATION FOR ASSISTANCE
This is a charitable organization not subject to rigors of HIPAA Compliance or enforcement. MOBL Charity takes every precaution to maintain the confidentiality of your records. Email is the most efficient way for us to gather information and access your situation as a team. This is a disclosure and your consent to allow email communication with PHI (protected health information) and PPI (protected personal information) which includes medical, personal and financial information.
MOBL Charity may follow up by phone or email for follow up information from applicant.
If you prefer to print our application instead of fill it out online, simply download the PDF, fill it out at your convenience, and email it to us when completed.