Patient Assistance Program Application
Epilepsy Alliance Louisiana will provide patient medical device assistance to patients living in Louisiana. EAL will review applications for patients for assistance related to the care of a person with epilepsy. Requests will be granted based on need and availability of funds.
To be eligible for financial assistance, a patient should fill out an application form and certify all information is true and correct to the best of their knowledge. EAL will not review applications if funds are unavailable.
Priority will be given to the following types of requests:
· Seizure Detection Device
· Job Training
· Medical Care
EAL is currently unable to approve the following requests through this program:
- Requests related to service or support animals
- Requests for travel to conferences or other activities
- Requests for scholarships
Applications will be reviewed and approved or denied based on the criteria listed above and the funds available. Additional information may be requested from the patient to better understand the application.
Financial requests will be fulfilled by payment to the authorized entity whenever possible.
Amounts may be granted in partial fulfillment of the amount requested.
EAL does not guarantee any medical or other outcome related to application requests and fulfillment of a request does not necessarily represent endorsement by or an official position of Epilepsy Alliance Louisiana. Advice regarding specific treatment or care of a patient should be obtained through consultation with a qualified medical professional.