PAG Application
The DSF Patient Assistance Grant Program offers grants to patients with Dravet syndrome and related epilepsies for necessary medical equipment, therapy devices, and educational aids associated with these conditions that are not covered through private insurance or other assistance programs. This program is open to all patients worldwide who are members of the DSF Family Network. The program closes each year on December 1st or once funds are depleted. Any remaining funds are rolled over, with the program opening each year on March 1st.
APPLICATIONS SUBMITTED PRIOR TO MARCH 1 WILL BE REJECTED
Application for Caregivers
Application for HCPs
Application for Caregivers
Your application packet should include the following documentation:
- Completed application
- A recent letter from the child’s physician or health care professional explaining the medical necessity of your request
- A letter of denial from the insurance provider stating that the requested equipment and/or service was denied (when possible)
- Proof of all income (including your most recent W2 form)
- Any other documentation pertaining to the nature of your request All information is kept confidential.
Application for Medical Professionals
The application is for medical professionals or social workers submitting on behalf of a patient. The application packet should include the following documentation:
- Completed application
- A recent letter from the child’s physician or health care professional explaining the medical necessity of your request. The request must be on the physician’s letterhead and list the patient’s diagnosis.
- A letter of denial from the insurance provider stating that the requested equipment and/or service was denied, if applicable. Not required for cooling vest, iPad, or seizure monitors (excluding Embrace2).
- Any other documentation pertaining to the nature of your request. All information is kept confidential.
The information collected by Dravet Syndrome Foundation will not be sold or distributed outside of DSF and is used solely to verify identity and assist with communication. Questions or concerns can be directed to our team.Â