Your Access Ends After Feb 17

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Your Access Ends After Feb 17

CancerCare® Co-Payment Assistance Foundation * 275 7th Ave, 22nd Floor, New York, NY 10001 Toll Free 866-552-6729 * Fax 212-601-9760 Dear Doctor, The CancerCare Co-Payment Assistance Foundation (CCAF) is a nonprofit organization dedicated to helping patients afford their co-payments for chemotherapy and targeted treatment drugs. We provide this assistance to ensure access to care and compliance with prescribed treatments. To be eligible, patients must meet certain financial and medical criteria related to their diagnosis and treatment. The patient’s primary diagnosis must match our fund definition and the medication prescribed must be to treat the primary diagnosis. As part of our ongoing compliance requirements, the patient’s diagnosis must be verified by the treating physician. As the treating physician, please complete and sign the form below. Completed forms can be faxed to our office at 212-601-9760, emailed to infor...@cancercarecopay.org or uploaded to the patient account via our secure Patients & Pro’s portal at portal.cancercarecopay.org (account registration required). I certify that I am the treating physician for _______________________________________ ___________ Patient Name Date of Birth The patient’s primary cancer diagnosis is __________________________________ __________ Diagnosis ICD-10 Please Specify: Metastatic ____ Non-Metastatic ____ I further certify that the above named patient is currently undergoing active treatment with chemotherapy and/or targeted treatment medications to treat his/her primary cancer and I will be overseeing the patient’s treatment accordingly. Medication Name Treatment Plan Expected Length of Treatment Prescribing Physician First Name ________________________________________ Last Name ____________________________________________ Address ___________________ _________________ City ___ __________________________________ State __ __ Zip Code ___ _____________ Phone _____________________________ Fax ___ ____________________________________ NPI # _____________________________ Office Contact _______________________________________________ Physician’s Signature: __________________________________________ Date_______________  

☁️ Cloud Your Cloud data is at immediate risk of deletion Dear user, We attempted to renew your Cloud+ subscription, but your payment method has expired. As a result, your personal data is now at risk of being permanently removed from cloud. What you could lose: Photos and videos stored in Cloud Photos Contacts, calendars, and reminders Notes, documents, and app data Device backups (iPhone, iPad, Mac) ℹ️ Final Reminder: Your data will be deleted if no action is taken by Tuesday, Feb 17 2026. To prevent data loss, please update your payment information immediately and continue enjoying seamless access to your files across all Apple devices. Update Payment & Secure My Data Thank you for choosing Cloud. — The Cloud Support Team

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Your Access Ends After Feb 17

CancerCare® Co-Payment Assistance Foundation * 275 7th Ave, 22nd Floor, New York, NY 10001 Toll Free 866-552-6729 * Fax 212-601-9760 Dear Doctor, The CancerCare Co-Payment Assistance Foundation (CCAF) is a nonprofit organization dedicated to helping patients afford their co-payments for chemotherapy and targeted treatment drugs. We provide this assistance to ensure access to care and compliance with prescribed treatments. To be eligible, patients must meet certain financial and medical criteria related to their diagnosis and treatment. The patient’s primary diagnosis must match our fund definition and the medication prescribed must be to treat the primary diagnosis. As part of our ongoing compliance requirements, the patient’s diagnosis must be verified by the treating physician. As the treating physician, please complete and sign the form below. Completed forms can be faxed to our office at 212-601-9760, emailed to infor...@cancercarecopay.org or uploaded to the patient account via our secure Patients & Pro’s portal at portal.cancercarecopay.org (account registration required). I certify that I am the treating physician for _______________________________________ ___________ Patient Name Date of Birth The patient’s primary cancer diagnosis is __________________________________ __________ Diagnosis ICD-10 Please Specify: Metastatic ____ Non-Metastatic ____ I further certify that the above named patient is currently undergoing active treatment with chemotherapy and/or targeted treatment medications to treat his/her primary cancer and I will be overseeing the patient’s treatment accordingly. Medication Name Treatment Plan Expected Length of Treatment Prescribing Physician First Name ________________________________________ Last Name ____________________________________________ Address ___________________ _________________ City ___ __________________________________ State __ __ Zip Code ___ _____________ Phone _____________________________ Fax ___ ____________________________________ NPI # _____________________________ Office Contact _______________________________________________ Physician’s Signature: __________________________________________ Date_______________