What does the Leukemia Foundation Treatment Assistance Program application look like? How do I fill it out?

Beijing Red Cross Children's Leukemia Medical Aid Application Form (1) Name Gender Birth Year Ethnicity Photo ID No. Household area Family Address Contact Phone Consultation Hospital Disease Diagnosis Treatment Expenditure Expenditure Expenditure Expenditure Acceptance of Social Aid Hospitalization Hospitalization Number of hospitalizations Hospitalization time Self-supporting Medical Expenses Amount Whether urban household members are enrolled in Children's Medical Insurance Reimbursement Amount Whether rural household members are enrolled in the New Rural Cooperative Medical Insurance or Children's Medical Insurance Reimbursement Amount Whether rural household members are enrolled in the New Rural Cooperative Medical Insurance or the Children's Medical Insurance Reimbursement Amount Family members Name Work unit Occupation Residential address Income Individual application Audit opinion Township (street) audit opinion District and county Red Cross Society audit opinion Seal: Monthly day Seal: Monthly day Note: 1. The above information is to be filled in by the parents or legal guardian; 2. Relevant application materials and photocopies are attached (hukou booklet, certificate of the street township and township and certificate of the hospital); 3. This form and related materials are to be submitted in duplicate to the district and county Red Cross. The Red Cross will be able to provide you with the information you need to complete the application.