The goal of this application is to enable Rare Disease Ghana Initiative process claims for products and services intended for use by persons living with undiagnosed and rare diseases.
By filling and submitting this form, I grant Rare Disease Ghana Initiative the permission to use my information to process request for relief services on my behalf or my family under the Patient wellbeing and Care Coordination Program.
All information you provide in this application is secured and protected in compliance with the Data Protection Act, 2012 (Act 843) and the data protection policy set out by Rare Disease Ghana Initiative (read full policy here https://www.rarediseaseghana.org/privacy-policy/).
If you have any questions about the collection or use of this information, kindly contact Rare Disease Ghana Initiative via orphan@rarediseaseghana.org / info@rarediseaseghana.org ; or visit our office at MVWF+22 Adentan Municipality, Lakeside Estates, Ashale-Botwe, Greater Accra, Ghana.