Massachusetts Organ Transplant Fund Application Form - The Commonwealth Of Massachusetts Page 2
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2Applicant must provide the following required attachments:
A signed letter from the established transplant center, or current physician overseeing direct care related
to the transplant, providing diagnosis, patient status and patient’s current level of activity
Copy of most recent Massachusetts and Federal Income Tax Returns and Schedule HC (health insurance
verification form)
Send completed application form along with required attachments to:
Lea Susan Ojamaa, Director
Division of Prevention and Wellness
th
250 Washington Street, 4
Floor
Boston, MA 02108
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