REFER A CHILD

APPLICATION REQUIREMENTS AND GUIDELINES
 

The ELLE FOUNDAION INC. is a non-profit organization whose mission is to create memories of joy for children battling cancer by granting final wishes for children with a recurrence of cancer. The ELLE FOUNDATION is not affiliated with any other organization having similar objectives.


Applications will only be accepted for children diagnosed with a recurrence of cancer who are 19 years old and younger.  (If exceptional medical circumstances exist for children not within this age group – please contact the foundation).
Children must reside in the United States.
The child applying for the wish must have finished all forms of treatment and been in remission for at least 24 months. The Elle Foundation will exercise its limited discretion to grant a final wish within a shorter period when exceptional medical circumstances exist.
The child applying for the wish must have had a first wish granted and completed no less than 24 months (2 years) prior to applying for a final wish, written documentation is required. The Elle Foundation will exercise its limited discretion to grant a final wish within a shorter period when exceptional medical circumstances exist.
A detailed description of the final wish and why it is being requested must be included on the Wish Application. How and why it will differ from the first wish granted should also be included.
In cases of guardianship, proper documentation must be submitted to the Elle Foundation.
We do not grant wishes for travel outside the United States.
Wishes are for immediate family only, two parents, wish child and siblings. A nurse may be included only if a physician deems it medically necessary.
All expenditures must be made directly by the ELLE FOUNDATION; consequently, the ELLE FOUNDATION cannot accept an application where parents or guardians for a child’s wish have already expended funds.

The ORIGINAL Wish Application and the Physician's Information Form must be completed and returned to the ELLE FOUNDATION’S office by mail. The Release and Indemnification Form must be signed, witnessed and mailed with the completed applications. A current photo of the Wish Child must be enclosed with the application.


HIPAA NOTICE: - The United States Congress recently enacted the Health Insurance Portability and Accountability Act (HIPAA), which took effect on April 14, 2003. HIPAA was designed to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers. In order to comply with this federal law, The ELLE FOUNDATION, Inc. now requires that the parent/legal guardian sign and return the HIPAA Form in order to process the wish application. The physician’s application requires a response from the wish applicant’s treating physician. The physician should require the wish applicant’s parents/legal guardian to complete and sign a HIPAA form during the treatment process.
Please ensure, before returning the physician’s portion of your application, that signed copy of the HIPAA form accompanies this document. If a HIPAA form has not yet been completed, please call the treatment facility and request one.

Please note: the wish application cannot be processed without the signed HIPAA form.