Development and implementation of a patient assistance fund: a descriptive study

Table 1 PAF Checklist located in electronic health record (EHR)

Patient Assistance Fund (PAF) Checklist
Tab 1 – General Information
Student Name
Patient Name
Proposed Treatment Plan/Treatment Codes
Treatment Plan approved by faculty	Yes	No
Treatment Plan approved by patient	Yes	No
General Consent, Screening, and Comprehensive Exam Consent, PAF Consent all signed	Yes	No
Income Eligibility Requirements Passed	Yes	No
Tab 2 – Patient Circumstances
Brief synopsis of patient circumstances/why patient should be considered for funding
Tab 3– Approval or Denial
Approved	Yes	No
Denial Reasoning
Request for more information

ISSN: 1472-6963