Ilva Romano
Patient Care Fund

How to Apply

MAIL, EMAIL or FAX the form to:

Ilva Romano Patient Care Fund

(c/o Kessenich Family MDA ALS Center)

Attention: Gina Gonzalez, R.N.

1150 NW 14^th Street

Miami, FL 33136

FAX: 305-243-7525

Phone: 305-243-7400

Toll Free: 800-690-ALS1

EMAIL: Ggonzal4@med.miami.edu

Donations can be sent to the same address and made out to: Ilva Romano Patient Care Fund

Eligibility Requirements

Patient applicants must be a resident of Miami Dade, Broward, Monroe, or Palm Beach counties, Florida.
Patient applicants must disclose personal financial information, including a copy of TAX return information.
Patient applicants must provide documentation that all other avenues of funding have been exhausted.
Patient applicants must file for an Explanation of Benefit (EOB) with the insurance company.
Patient applicants need to provide complete information on services or equipment for which she/he is applying, and the associated cost.
Each service or piece of equipment assistance request requires that a separate application form be completed and submitted.