<html><body><b><font size="4">If you are blind and live in South Carolina, the Federation Center of the Blind has some talking medical devices available free of charge. This AFLAC grant ends July 1, next Friday, so you must act fast. First-come, first served while devices last!<br><br>You must have a need for these devices and have your doctor fax your need for them to David Houck at 803-252-5655 by Thursday, June 30. You may fill in below the application and email it back to me at nfbsc@sc.rr.com by Thursday, June 30.<br><br>If you are diabetic, we have talking glucometers<br>If you track your blood pressure, we have upper arm blood pressure monitors.<br>If you track tour body temperature we have talking thermometers.<br>If you track the oxygen level in your blood, we have talking oxymeters.<br><br>Fill out and return application below:<br><br>---------------------------------------------------------------------<br><br>In-Home Talking Medical Devices<br>Application Form<br><br>This project would not be possible without a generous grant from Aflac. The following information will be kept confidential. Once you have completed this application, please sign and mail it to the following address:<br>Federation Center of the Blind<br>TMD Project<br>119 S. Kilbourne Rd.<br>Columbia, SC 29205<br>Completed and signed applications can also be emailed to the Federation Center at nfbsc@sc.rr.com.<br>Please provide a written statement from your doctor on business letterhead verifying the need for te specific talking in-home medical device. Please be specific as possible. Only one device will be considered for each applicant at this time. No applications will be considered until a doctor's statement is also received.<br>Once this application and doctor's statement are received, the Talking Medical Device Review Committee will review the applications and notify the individual of the determination. The TMD review committee will meet buwekly but will adjust the meeting frequencies as determined by the applications received.<br><br>-----------------------------------------------------------<br><br>Name: __________________________________________<br><br>Street address ____________________________________<br><br>City, State, Zip ____________________________________<br><br>Phone Home _______________________________________<br><br>Phone Cell________________________________________<br><br>Date of Birth ________________________________________<br><br>Are you legally blind? ____ Yes ____ No<br><br>Health condition you need to track:<br><br>___ Blood Sugar<br><br>___ Weight Control<br><br>___ Body Temperature<br><br>___ Blood Pressure<br><br>___ Daily Walking/Number of Steps<br><br>___ Oxygen level<br><br>___ Other: _______________________________________________________<br><br>Please explain in your own words the reason you need a talking in-home medical device:<br><br>______________________________________________________________________________<br><br>______________________________________________________________________________<br><br>_____________________________________________________________________________<br><br><br>_______________________________________<br>Signature<br><br>________________________________________<br>Date<br><br><br><br></font></b></body></html>