921 E. 34th Street
Suite A
Joplin, MO 64804
Phone: 417.347.6639
Fax: 417.347.0333

Business Hours: Mon-Thu 8am-4:30pm, Fri 8am-4pm

ASSISTANCE BY APPOINTMENT ONLY
PLEASE CALL 417.347.3793 or 417.347.6639
Tuesdays 8:30am – 12:00pm
Wednesdays 9:00am – 1:00pm & 2:00pm – 4:30pm
Thursdays 1:00pm – 4:30pm
Must have verification of a provider appointment to receive assistance.
APPLICATION FOR ASSISTANCE
Children's Miracle Network Hospitals is a charity designed to assist families of sick or injured dependent children 21 years or younger, living in our 14-county service area.
Funds are provided after Medicaid and/or private insurance have distributed their resources.
HOW TO APPLY FOR FUNDING:
  1. Fill out the application completely and sign it.
  2. Documentation is required for CMN assistance. These documents can be emailed or dropped off at our office. Email: IAMedrano@freemanhealth.com
    • Referral letter from Freeman physician
    • Proof of residency
    • Insurance card for child
    • For travel:
      • Appointment confirmation from hospital/clinic (Kansas City, St. Louis, Springfield)
      • Verification of appointment attendance after (ie school note or discharge papers)
    • For medication:
      • Copy of the prescription
    • For special equipment:
      • Letter of Medical Necessity
      • Medicaid or insurance denial letter
  3. All requests for assistance must be submitted 72 hours in advance of the appointment (see CMN appointment hours above). Request for supplemental items should be requested 1 week in advance to account for potential shipping delays.
  4. If there are any future changes to the information submitted on this application, please contact the office to update.
CHILDREN’S MIRACLE NETWORK HOSPITALS CANNOT PROVIDE FUNDING FOR:
Child Information
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Parent or Guardian #1
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Parent or Guardian #2 optional section
Medical Information
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Other Medical Information optional section
Assistance Requested