One of the required documents that we must receive with your child's application is a certification from your child’s physician of the medical condition(s) relating to the items you are seeking assistance.
1. Download and print a copy of the Physician’s Certification of Medical Condition Form by clicking here.
2. Complete the top portion of form and provide to your child’s physician to complete the bottom portion.
3. The form MUST be completed and signed by an M.D. (Doctor of Medicine), D.O. (Doctor of Osteopathic Medicine), or for hearing-relating conditions, an Au.D. (Doctor of Audiology) within the last 6 months.
4. After you receive the completed form back from your child’s physician, please scan a copy to your computer (you may also take a picture of each side) and attach it to your child's grant application when submitting online.
September 26, 2017
The 6th Annual UHCCF Northeast Golf Event at Lake of Isles Golf Club & Resort in Connecticut will take p... more >
July 31, 2017
Please join us on Monday, July 31, 2017 at the Hazeltine Golf Classic to benefit the UnitedHealthcare Chi... more >
July 30, 2017
Information about this event is coming soon! more >
Could your child benefit from a medical grant?
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