This document, intended for a hospital setting, provides a sample job description, list of justifications for creating the position and a projection of budget savings from creation of the position.
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Patient Assistance Program Center
Sample Program Documents
See also:
posted: 02/11/2009
Example of letter certifying patient’s need.
posted: 02/11/2009
PAP Information and Signature Authorization Form
posted: 02/11/2009
Patient Consent and Release for Exchange of Information
posted: 02/11/2009
Example appeal letter without Medicare Part D
posted: 02/11/2009
Example appeal letter with Medicare Part D.
posted: 02/11/2009
Example of Letter to appeal program decision.
posted: 02/11/2009
Example of Zero Income Attestation (no income letter).
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