RE: Financial Worksheets - Do you use them and if so, are they an effective tool?

[Guest guest]

Jacqui,

Our programs use one of these; however, we find this particular

piece to come much better from the social worker’s and they complete with

the patient at the time of evaluation.

They are already looking at all the social aspects of care,

including the non-insurance financial piece. This gives our social worker’s

and TFC’s the opportunity to collaborate better.

Debbie Mast

Database Administrator/Financial Manager

Solid Organ Transplant/VAD Program

Stanford Hospital and Clinics

750 Welch Road, Suite 220

Palo Alto, CA 94304

Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal

Transplant Programs

Trustee, TFCA

Phone: Fax:

www.donateLIFEcalifornia.org/stanfordmed

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of jacqui_duran

Sent: Friday, March 16, 2012 12:56 PM

To: TxFinancialCoordinators

Subject: Financial Worksheets - Do you use

them and if so, are they an effective tool?

My center is working on

presenting patients with a Transplant Financial Worksheet. (I have copied

a version here - so you can have an idea of what I'm talking about - I hope it

comes through on your end) I am curious though, if any other centers use

a form similar to this. If so ...

Do

you complete this with the patient, or simply give to them to use as a

personal tool?

Have

you found this to be effective post transplant or even pre-transplant, (as

a way to assess financial needs/concerns before evaluation begins)?

If

you use something like this, do you find that patients appreciate this or

simply blow it off?

Any input you have, or any

forms you have and use would be greatly appreciated! You can email me

directly if you'd wish: jduran@...

Thank you in advance for your help, experience and suggestions!!

-Jacqui Duran, Liver

Transplant Financial Coordinator

Saint Luke's Hosptial of

Kansas City | 4401 Wornall Rd, Kansas City, MO 64111 |

This

worksheet is a tool for you and your Transplant Team to help you with your

financial planning in regards to your potential transplant. It is imperative

that the information you provide is as accurate as possible, as this is what we

need to know to be able to make this affordable for you and not to be a burden

on you. If your financial status changes, please bring it to the attention of

your Transplant Financial Coordinator as we can work to find ways to help you.

Monthly Income

Monthly

Income $_________________ Total Household Income: $________________

Source:

__________________________________________

Spouse

Monthly Income $_________________

Source:

__________________________________________

Other

Income: $_________________

(child

support, SSDI, alimony, etc)

Source:

__________________________________________

Monthly Expenses

Rent/Mortgage

$_________________ Total Expenses: $_______________

Utilities:

Gas

$_________________

Electric

$_________________

Water

$_________________

Trash

$_________________ Balance Card:

Total

Household Income

$

Total

Monthly Expenses

-$

Total

$

Phone

(Cell) $_________________

Internet

$_________________

Other

$_________________

Insurance:

Auto

$_________________

Health

(spend down) $_________________

Dental

$_________________

Vision

$_________________ Take the Total here and insert it below:

Total

Income after Expenses

$

Approx

Cost of Immunosuppression medications

-$

Total

$

Life

$_________________

Loans:

Auto

(Car, Boat, etc.) $_________________

Student

Loans $_________________

Personal

$_________________

Credit

Card Payments:

#1

____________________ $_________________

#2____________________

$_________________

#3____________________

$_________________

Monthly

Expenses:

Food &

Groceries $_________________

Maint/Repairs

(home, car) $_________________

Childcare

$_________________

Clothing

$_________________

Current

Medication Costs $_________________

Other

expenses:

#1____________________

$_________________

#2____________________

$_________________

[Guest guest]

Jacqui,

Our programs use one of these; however, we find this particular

piece to come much better from the social worker’s and they complete with

the patient at the time of evaluation.

They are already looking at all the social aspects of care,

including the non-insurance financial piece. This gives our social worker’s

and TFC’s the opportunity to collaborate better.

Debbie Mast

Database Administrator/Financial Manager

Solid Organ Transplant/VAD Program

Stanford Hospital and Clinics

750 Welch Road, Suite 220

Palo Alto, CA 94304

Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal

Transplant Programs

Trustee, TFCA

Phone: Fax:

www.donateLIFEcalifornia.org/stanfordmed

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of jacqui_duran

Sent: Friday, March 16, 2012 12:56 PM

To: TxFinancialCoordinators

Subject: Financial Worksheets - Do you use

them and if so, are they an effective tool?

My center is working on

presenting patients with a Transplant Financial Worksheet. (I have copied

a version here - so you can have an idea of what I'm talking about - I hope it

comes through on your end) I am curious though, if any other centers use

a form similar to this. If so ...

Do

you complete this with the patient, or simply give to them to use as a

personal tool?

Have

you found this to be effective post transplant or even pre-transplant, (as

a way to assess financial needs/concerns before evaluation begins)?

If

you use something like this, do you find that patients appreciate this or

simply blow it off?

Any input you have, or any

forms you have and use would be greatly appreciated! You can email me

directly if you'd wish: jduran@...

Thank you in advance for your help, experience and suggestions!!

-Jacqui Duran, Liver

Transplant Financial Coordinator

Saint Luke's Hosptial of

Kansas City | 4401 Wornall Rd, Kansas City, MO 64111 |

This

worksheet is a tool for you and your Transplant Team to help you with your

financial planning in regards to your potential transplant. It is imperative

that the information you provide is as accurate as possible, as this is what we

need to know to be able to make this affordable for you and not to be a burden

on you. If your financial status changes, please bring it to the attention of

your Transplant Financial Coordinator as we can work to find ways to help you.

Monthly Income

Monthly

Income $_________________ Total Household Income: $________________

Source:

__________________________________________

Spouse

Monthly Income $_________________

Source:

__________________________________________

Other

Income: $_________________

(child

support, SSDI, alimony, etc)

Source:

__________________________________________

Monthly Expenses

Rent/Mortgage

$_________________ Total Expenses: $_______________

Utilities:

Gas

$_________________

Electric

$_________________

Water

$_________________

Trash

$_________________ Balance Card:

Total

Household Income

$

Total

Monthly Expenses

-$

Total

$

Phone

(Cell) $_________________

Internet

$_________________

Other

$_________________

Insurance:

Auto

$_________________

Health

(spend down) $_________________

Dental

$_________________

Vision

$_________________ Take the Total here and insert it below:

Total

Income after Expenses

$

Approx

Cost of Immunosuppression medications

-$

Total

$

Life

$_________________

Loans:

Auto

(Car, Boat, etc.) $_________________

Student

Loans $_________________

Personal

$_________________

Credit

Card Payments:

#1

____________________ $_________________

#2____________________

$_________________

#3____________________

$_________________

Monthly

Expenses:

Food &

Groceries $_________________

Maint/Repairs

(home, car) $_________________

Childcare

$_________________

Clothing

$_________________

Current

Medication Costs $_________________

Other

expenses:

#1____________________

$_________________

#2____________________

$_________________