Directions for Completing and Submitting
Application Requesting Assistance for Surgery

Attention: When completing and submitting the Application Requesting Assistance for Surgery,
the Projects Form must also be completed at the same time.

Application Requesting Assistance for Surgery     Projects Form

  1. No after-the-fact cases will be accepted.
  2. The sponsoring club pays for examination(s), if possible.
  3. The Foundation only pays amounts approved on surgical cases.
  4. The Medical Agencies bills  MD-35 Projects Chairperson. This information is provided to them on the Aurhorization Form when the case is approved.
  5. When you receive a request for financial assistance for surgery, complete in full both the Projects Form and the Financial Eligibility Application form with necessary signatures using the Poverty Level Schedule as a guideline. Both forms must be completed!
  6. All clients must apply for assistance from the Division of Blind Services (DBS) and Vocational Rehab before coming to the Foundation. If they are denied assistance from DBS or Voc Rehab have them get a letter stating reason for denial and submit it with the application. The Foundation does not get involved with clients who have Medicare, Medicaid, or any other form of insurance.
  7. Your club's co-payment must accompany the required forms when submitting a request for assistance. Please make the check payable to: The Florida Lions Foundation for the Blind, Inc. The requested amount is $200.00 per surgical case for either one or two eyes.
  8. Please attach a copy of the patient's social security card or a copy of their Green Card if applicable to the forms.
    A. Clubs with emergency cases must immediately notify District Projects Chairperson.
    B. One-eye cataract cases are not emergency cases.
    C. Esotropia, exotropia, and lazy eye are emergencies only for ages 5 and under.
  10. If a case is not completed within 6 months following approval it will be cancelled.

Note: Your assistance in making sure all information needed is provided on the forms will greatly expedite the process. Please remember that it is not the responsibility of the Projects Chairperson to acquire the client's information. It is our responsibility to try to negotiate costs with medical agencies once we receive the precise procedure to be done with the code numbers and the estimated costs.

If you have any questions, please call the MD-35 Projects Chair, Beverly Kruger, or your District Projects Chair. Their names and phone numbers are listed in your District Directory under Florida Lions Foundation for the Blind, Inc, or on this website by clicking here. The Foundation is here to assist all Lions Clubs in Florida and The Bahamas.

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