In order to ensure we are in compliance with United States law, our organization is required to demonstrate accountability in how our donated funds are utilized.
To oversee the funding of medical assistance in Lebanon, the Mission’s medical aid committee, comprised of U.S. health care professionals, maintains records of each patient and the treatment they receive that is funded by our charity.
In order for our organization to disperse funds for the care you have provided, we require the following
information from you:
- Patient name
- Personal Identification
- UN Papers
- Provider name and hospital/clinic
- Diagnosed condition
- Treatment rendered
- Recommended follow-up care, to include medications
- Hospital Discharge Papers
- Hospital Financial Information for Billing Payment:
- Hospital Bill
Please document your responses in the blank space below, in the following order specified in the information above.
The St. Rafka Mission of Hope and Mercy greatly appreciates your assistance and is grateful to you for the care you have provided to this vulnerable and suffering population.
God bless you
Medical aid committee members
Apostolate of Our Lady of Hope, St. Rafka Mission of Hope and Mercy
MEDICAL SERVICES APPLICATION ACKNOWLEDGMENT AND APPRECIATION LETTER