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PATIENT ASSISTANCE
applying for ASSISTANCE
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Complete the Southeastern Cancer Care Application
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Provide Proof of Income (1 of the following)
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W-2's, 1099's or Schedule C's
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3 months of consecutive pay stubs
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Letter from employer stating pay
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Copy of most recent bank statement
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A letter from your doctor verifying your current diagnosis and detailing treatment plan.
Questions about qualifications or the application process? Call us at 919-587-9056 or email us at southeasterncancercare@gmail.com.

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