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  • MedicAlert IDEA Program Application

  • The Inclusion, Diversity, Equity in Action (IDEA) Program provides financial support to people who may have challenges accessing health care services for a number of reasons. There are many things we consider in reviewing your application including financial resources, gender, living situation, race and sexual orientation. Why do we look at these things? Sometimes it is not just financial challenges that make access to health care services difficult. Our goal is to make access to our services as fair as possible for all.


    The IDEA Program works by waiving all or some of the cost of MedicAlert's services to those most in need.

    It takes about 15 minutes to complete this form. You will not be able to save your work and return later. Please ensure you have enough time to complete the application.

    Before starting, please make sure you have proof of income documentation for each income-earning member of the family:

    • Most recent Notice of Assessment for each income-earning member of the family.
    • Last year’s T4/T4A slips for each income-earning member of the family.
    • Last 2 pay stubs for each income-earning member of the family
  • Applicant information.

  • IDEA Program Consent


    MedicAlert is committed to making its services accessible to all members of the community, including the marginalized and underserved people. To help us determine if you qualify for the Program, we need your permission to collect specific information from you.

    What is the IDEA Program and how does it work?
    The IDEA Program provides financial assistance to people who may have challenges accessing our services. This Program works by waiving all or a portion of the cost of MedicAlert's services to those who are in need. MedicAlert has developed an assessment tool that uses an income means test based on where you live and how big or small your family is. The tool also considers things like race, language, your understanding of health terms, gender and other things that can impact people’s ability to access care. Our goal is to make access to our services as fair as possible for all.

    What information is being collected?
    To see if you qualify for the IDEA Program, you will be asked a series of questions about your income, race, ethnicity, household size, housing arrangements, and health conditions.

    Do I have to answer all the questions?
    No, you do not have to answer all the questions. However, withholding certain information may affect our ability to accurately assess your application, which may impact your ability to receive full or partial financial support. We recommend that applicants answer all the questions.

    For what purposes is my information being collected?
    MedicAlert needs to collect your information in order to assess your eligibility for the IDEA Program.

    Are there other ways in which MedicAlert will use my information?
    Yes. MedicAlert may conduct research or engage third parties to conduct research using your information. Any research will be conducted for the purposes of healthcare research, health promotion and prevention programming, and to improve MedicAlert's programs and services. Your name and personally identifiable information will not be shared and will not appear on any report or in any research findings.

    With whom will MedicAlert share my information?
    MedicAlert staff may need to share your information internally in order to assess your eligibility for the IDEA Program. In addition, your information may be shared with third parties in order to conduct research, as stated above. We may also contract with third party service providers to help us administer the IDEA Program.

    How does MedicAlert safeguard my personal information?
    All the information you provide to MedicAlert will remain confidential. All MedicAlert staff are bound by confidentiality agreements and are subject to the appropriate training and oversight to ensure that your information will be properly safeguarded. Prior to contracting with a third party service provider, we conduct the appropriate due diligence to ensure that they meet our privacy and security standards.

     

    Can I withdraw my consent? What happens if I do?
    You may withdraw your consent at any time by contacting us at idea@medicalert.ca. If you withdraw your consent, your information will no longer be used and you will cease to qualify for the subsidy unless you contact us again to reapply for the Program.

    If I am not a current MedicAlert subcriber, does providing my information for eligibility assessment mean I am now a MedicAlert subscriber?
    No, it does not. The information you provide will be used for the purposes stated above. After you complete our intake process and answer the questions, we will notify you of the outcome of the assessment within 5 to 7 business days. If you qualify for the program, it is your choice to become a MedicAlert subscriber or not. We will provide you with information on how to do so.

  • Details of person applying on behalf of the applicant. 

  • Please contact the following with any follow-up questions or when this applications is processed.

  • Applicant details.

  • Age

  • Location

  • Applicant contact information.

  • If we have any follow up questions, what is the best way to reach you?

  • Do you have any of the following?

  • Household income.

    Income determines someone's overall living conditions and greatly influences their diet, physical activity, and ultimately their health.

  • Verify your income

    Submit documents from all income sources. You can upload multiple files.  File(s) must be an image jpg/jpeg, png, gif, or pdf and cannot be larger than 30mb.

    Examples of documents accepted as proof of income:

    • For employed: Notice of Assessment for each income-earning member of the family OR last year T4/T4A slips for each income-earning member of the family.

    • For newly employed: Last two pay stubs for each income-earning member of the family.

    • For recently unemployed: Employment Insurance documents

    • For disabled individuals: Disability benefit monthly statements

    • For retired individuals: Notice of Assessment OR Canada Pension Plan payments (CPP) statement

    • For new immigrants or refugees: Income assistance documents.

    • For students: School IDs indicating your name, the school and academic year, plus any provincial student assistance benefit document such as OSAP (Ontario Student Assistance Program)

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  • How well do you understand the health information provided to you by your care providers?

    Health literacy refers to the skills someone needs to understand and make decisions about their health

    Choose the option that best applies to each statement.

  • I am able to describe my health concerns to others

  • I am able to judge which health information can be trusted

  • I am able to understand the health information provided by my care providers

  • I am able to ask/ find the health information I want

  • What healthcare services did you access in the last 12 months?

    It is important for everyone to be able to get care when they needed it, and have a provider that knows their medical history.

  • Which did you access the most?

  • Which language is most spoken by health care providers and first responders in your area?

  • How well do you speak {selectOne123}?

    A person will have difficulty communicating with care providers if they don't speak the same language.

  • How well do you speak {selectOne123}?

  • What language would you feel most comfortable speaking in with your healthcare provider?

  • Do you have any of the following communication disabilities?

  • Which of the following best describes your racial or ethnic group?

    Visible minority and Indigenous populations face numerous health inequities related to racism.

  • Were you born in Canada?

    Research shows that immigrants to Canada experience worse health status relative to non-immigrants.

  • What is your residency status?

  • What is your highest level of education?

    Someone's level of education plays an important role in determining their health. Those with more education are likely to have higher incomes, less hazardous work, better housing and food. 

  • Are you currently employed?

    The type of work someone does has a direct impact on their health and wellbeing. 

  • What are your current working conditions?

  • Food Security.

    Someone is food insecure if they have trouble accessing or affording adequate "amount/quality" of food. Those that are food insecure are at increased risk of developing chronic diseases.

    Please read the following statements and indicate whether this was true for you or other members of your household within the last 12 months.

  • The food I/we bought didn't last and we didn't have money to buy more

  • I/We could not afford balanced Meals

  • I/We have help from a foodbank, or community food program, or from friends/family

  • Please select your current housing condition.

  • This includes people who lack housing and do not normally use emergency shelters or accommodation, except during extreme weather conditions. E.g. parks, public spaces, vacant buildings (squatting), living in a vehicle, tent or other makeshift shelter.

  • This refers to people who use emergency shelters and system supports. E.g. Emergency overnight shelters, shelters for individuals and families impacted by violence, or shelters for those impacted by a natural disaster.

  • This describes situations in which people, may be living in temporary housing provided by government or the non-profit sector (transitional housing), have short-term accommodation with friends, family, or even strangers (couch surfing), who are temporarily living in hostels, motels or rooming houses, or new immigrants living in a reception center without means to secure their own residence. 

  • This refers to those for whom a single event, unexpected expense, or crisis is all it may take for them to lose their housing. E.g. illness, loss of work, loss of income support, family separation/divorce, violence, etc. 

  • This refers to those who are living somewhere that is reasonably maintained and is affordable for the individual/family. This includes rent-to-income or other forms of rent or income subsidy. 

  • What is your gender?

    Due to widespread and persistent individual and systemic discrimination, gender and sexually diverse populations experience reduced access to quality health care and under-utilization of health care services.

  • What is your sexual orientation?

    Due to widespread and persistent individual and systemic discrimination, gender and sexually diverse populations experience reduced access to quality health care and under-utilization of health care services.

  • Review your application.

  • Applicant details

  • First and last name

    {firstName} {lastName}

    Age

    {ageHelper}

     

    Address

    {ClientMailingAddressE}

    {ClientPostalCode}

  • Nom et prénom

    {firstName} {lastName}

    Âge

    {ageHelper}

     

     

     

  • Applicant contact information

  • Email

    {email}

    Phone number

    {phoneNumber317}

    If we have any follow-up questions, what is the best way to reach you?

    {selectAll}

    Referral organization

          {referredBy}

          {referralOrganizationCN}

          {referralOrganizationName}

          {referralOrganizations#}

  • Email

    {email}

    Numéro de téléphone

    {phoneNumber317}

    Si nous avons des questions complémentaires à vous poser, quel est le meilleur moyen de communiquer avec vous?

    {selectAll}

    Où avez-vous entendu parler de ce programme?

    {referredBy}

    {referralOrganizationCN}

    {referralOrganizationName}

    {referralOrganizations#}

     

  • Details of person applying on behalf of the applicant

  • First and last name

    {firstName96} {lastName97}

    Relationship with the applicant

    {relationshipWith}

    Postal Address

    {HelperMailingAddressE}

    {postalCode348}

    Phone Number

    {phoneNumber326}

    Please contact the following with any follow-up questions or when this applications is processed.

    {selectAll104}

     

  • Nom et prénom

    {firstName96} {lastName97}

    Relation avec le demandeur

    {relationshipWith}

     Numéro de téléphone 

    {phoneNumber326}

    Veuillez contacter les personnes suivantes pour toute question de suivi ou lorsque cette demande est traitée.

    {selectAll104}

  • Underlying conditions

  • Conditions

    {selectAll43}

  • Household Income

  • How many people does this income support?

    {incomeHelper}

    What is the total gross household income before tax? ($)

    $ {whatIs47}

  • Nombre de personnes qui vivent grâce à ce revenu (taille de la famille) : 

    {incomeHelper}

    Quel est le revenu brut total de votre ménage (avant déductions), toutes sources confondues? ($)

    $ {whatIs47}

  • Healthcare proficiency

  • I am able to describe my health concerns to others

    {selectOne109}

    I am able to judge which health information can be trusted

    {selectOne111}

    I am able to understand the healt information provided by my care providers

    {selectOne113}

    I am able to ask / find the health information I want

    {selectOne115}

  • Je suis capable d’expliquer mes inquiétudes en matière de santé à d’autres personnes

    {selectOne109}

    Je sais reconnaître les renseignements médicaux qui sont dignes de confiance

    {selectOne111}

    Je comprends les renseignements médicaux que me donnent mes fournisseurs de soins de santé

    {selectOne113}

    Je suis capable de demander/de trouver les renseignements médicaux dont j’ai besoin

    {selectOne115}

  • Healthcare access

  • Access to health

    {selectAll118}

  • Accès aux soins

    {selectAll118}

  • Language proficiency

  • Which language is most spoken by health care providers and first responders in your area?

    {selectOne123}

    How well do you speak {selectOne123}?

    {languageHelper}

    Most comfortable language

    {comfortableLanguage246}  {pleaseSpecify281}

  • Quelle langue est le plus parlée par les fournisseurs de soins de santé et les premiers intervenants dans votre région?

    {selectOne123}

    Quel est votre niveau de maîtrise de la langue ({selectOne123})?

     {languageHelper}

    Langue la plus confortable

    {comfortableLanguage246}   {pleaseSpecify281}

  • Communication disabilities

  • Communication 

    {selectAll136} 

    Require support to communicate

    {describeSupport}

    Other issue

    {describeIssue}

  • La communication 

    {selectAll136} 

    Besoin d'aide pour communiquer

    {describeSupport}

    Autre

    {describeIssue}

  • Ethnicity and residency status 

  • Ethnicity

    {ethnicityHelper} {otherEthnicity}

    Place of birth

    {placeOf252}

    Residency status

    {selectOne60}

  • Ethnicité

    {ethnicity}  {otherEthnicity}

    Lieu de naissance

    {placeOf252}

    Statut de résidence

    {selectOne60}

  • What is your highest level of education? 

  • Education

    {selectOne64}

     

  • Éducation

    {selectOne64}

     

  • Employment and working conditions 

  • Employment Status

    {selectOne67}

    Occupation details

    {selectAll69}

  • Votre situation d'emploi

     {selectOne67}

    Détails de la profession

    {selectAll69}

  • Food Security 

  • The food I / we bought didn't last & we didn't have $ to buy more

    {selectOne73}

    I / We could not afford balanced Meals

    {selectOne75}

    I / We used a food bank

    {selectOne77}

  • La nourriture que j’ai/nous avons achetée a vite été consommée et je n’avais/nous n’avions pas assez d’argent pour en acheter davantage

    {selectOne73}

    Je n’ai/nous n’avons pas les moyens de manger des repas équilibrés

    {selectOne75}

    J’ai/nous avons eu recours à une banque alimentaire ou à un programme d’aide alimentaire communautaire (p. ex. Popote roulante ou d’autres services de repas gratuits), ou j’ai/nous avons reçu de la nourriture gratuite de la part d’amis ou de membres de la famille.

    {selectOne77}

  • Housing conditions

  • Housing

    {selectOne80}

  • Conditions de logement

    {selectOne80}

  • Orientation & gender 

  • Orientation

    {selectOne87}

    Gender

    {selectOne84}

  • Orientation

    {selectOne87}

    Genre

    {selectOne84}

  • Should be Empty: