Treatment Assistance Program Application Instructions

The Mary K Richter Treatment Assistance Program

Treatment Assistance Application Instructions

Needed Materials

Any individual applying for funding through the Treatment Assistance Program must provide the following:

• Completed application form
• Two recent photographs of the affected individual at least 2”x3” in size: one forward facing portrait (front view) and one profile (side view).
• Provide a letter from the applicant’s primary physician (not dentist) confirming the diagnosis. This letter must be written on official letterhead, signed by the physician and document the ectodermal dysplasia clinical manifestations that the affected individual demonstrates (e.g., hair, teeth, sweat, nails, or any other). Genetic testing reports will also be accepted.
• For cooling products ONLY: include why the patient is at risk for overheating and a cooling product is medically necessary.
• Quotes of the desired window air conditioning unit, cooling vest, or wig, if applicable.
• Be a registered NFED member. If you are not already, you can register your family at nfed.org/join-us/.