Open Arms of Minnesota provides home-delivered medically tailored meals and nutrition services to clients free of charge. This application collects information required to determine eligibility.
This form is for clients with: Cancer, MS, ALS, ESRD (on dialysis), CHF, COPD, other diagnoses.
Eligibility for service is determined based on medical and nutritional status. Clients who do not have one of the diagnoses listed above may be eligible for short-term service only.
Note: in order to submit this form, you will need to provide the email address or fax number of your doctor, nurse, medical case manager, or medical social worker. Please make sure to have this information ready before starting this form. If you are not able to provide this information, contact Client Services at 612-767-7333 or firstname.lastname@example.org.
Please note that only completed applications will be accepted. Applications must include all signatures to be considered complete.
Step 1: Complete this application form. Include a fax number or email address for your healthcare provider, and the system will automatically send them the next step.
Step 2: Your healthcare provider will receive an email or fax with the medical portion of this form. They will need to complete and sign that form and return it to us before we can process your application.“
QUESTIONS? Contact Client Services at 612-767-7333 or email@example.com.