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CARING HANDS IN HEALTH PORTAL

Patient Application

Note: Only a medical provider that is a member of the San Mateo Medical Center network of clinics, including those located offsite from the main campus, can fill out forms on behalf of patients.

You can submit a HIPAA compliant application on behalf of a patient or patient guardian by clicking the button below. If this is the first time you are submitting an application, please review the program information included in the next section.

Click here if the button does not load.

Program Information and Tutorial

  • You can learn about the program scope, eligibility requirements, and application process by viewing this PowerPoint.

  • Check back soon for the program training video. You can still view a walkthrough on how to submit an application by reading the PowerPoint above.

Frequently Asked Questions (FAQ)

Who qualifies for support from the Caring Hands in Health program?
To align with IRS regulations, program recipients must constitute a “charitable class.”(e.g., individuals
facing economic hardship or children) and show need by meeting the program eligibility requirements
which are specific to the San Mateo County Health Foundation’s cause and work to identify individuals
most in need of assistance. The Caring Hands in Health program eligibility requirements are listed below:

  • Recipient must be a patient or patient guardian of San Mateo County Health facilities - must possess a MR Number

  • Recipient must live in San Mateo County

  • Recipient must be referred to by one of our providers who has attested to the needs of the patient or patient guardian

Who can submit an application on behalf of a patient?
The program application should be completed by a San Mateo Medical Center or clinic healthcare provider via the online application page. Patient consent via signature must be included at the time of submission via the application form.

Can a patient who is under the age of 18 apply for assistance from the program?
Yes, applications can be submitted on behalf of patients of any age. If a patient is under the age of 18 years old, a parent or guardian is required to give their consent and sign the program application at the time of submission. Applications of patients under the age of 18 years old that do not include a guardian’s signature will not be considered. 

Where can a provider submit an application on behalf of a patient?

A provider can submit an application via the program's HIPAA compliant application at this link

Can a patient apply for support through the program multiple times?
Patients can apply and receive assistance funds up to three times per year. If a third application is submitted within a year for one patient, the Board must review this application before it is approved.

How long does the application process take once an application is submitted?
A dedicated member of the San Mateo County Health Foundation support staff will process applications weekly. Applicants will be notified of the status of their application within one week of application submission.

How do I obtain an applicant’s permission if they are attending a virtual appointment?
In cases where the patient is being treated virtually, providers can attest on the application that they have been given phone consent by the patient or individual authorized to consent the patient’s full name.

How do patients find out if their application has been approved?
Applicants will be notified of the status of their application within one week of application submission directly by program support staff of the San Mateo County Health Foundation. In situations where contact with patients or patient guardians is unable to be made, the San Mateo County Health Foundation will contact San Mateo Medical Center or the submitting clinic for additional support to reach the patient.

Once approved, how do patients obtain their assistance from the program?
The Foundation will conduct an entirely in-person delivery model, distributing assistance in the form of cash, checks, gift cards, or prepaid cards to recipients by specifying a meeting time or pick-up location. When notifying patients regarding the approval of their application, the San Mateo County Health Foundation staff member will arrange the pick-up location or delivery of the assistance. In situations where patients are unable to collect their assistance, a member of the San Mateo County Health Foundation will deliver the assistance to the patient or patient’s guardian at a predetermined location.

CONTACT US

Still have questions about the program or need further assistance submitting an application? Please contact the San Mateo County Foundation team at info@smchf.org.

Thank you for helping us build this program. It is thanks to providers like you and programs like these that 80,000 patients a year can receive healthcare regardless of ability to pay. You can further support the program by clicking the donation button at the top.