REFERRING CLINICIANS
Partner with iTASC to Help Patients Access Vital Care.
As a healthcare provider, you play an essential role in guiding patients toward the care they need. By partnering with iTASC, you can connect underserved individuals with free, high-quality skin cancer treatment provided by our network of volunteer Mohs surgeons. Together, we can ensure every iTASC patient faces skin cancer with hope and support.
- Step 1. Provider Registration.
- Step 2. Qualify the Patient Financially.
- Step 3. Qualify the Cancer.
- Step 4. FAX Completed one-step patient referral form: Send referral form along with supporting documents to 937-345-2351 to connect eligible patients to our program.
Supporting PATIENT documents- Patient Signed iTASC Consent and Release
- Patient Signed iTASC HIPAA Authorization
- Patient Signed iTASC Media Release
Frequently Asked Questions
How to qualify a patient without insurance as economically disadvantaged
The referring provider’s office is required to verify the patient meets iTASC Income Threshold levels based on family size. The following information can be used as a general guideline:
| Family Size | 2024 Federal Poverty Level | iTASC Income Thresholds (220% of FPL) |
| Individual | $15,060 | $33,132 |
| Family of 2 | $20,440 | $44,968 |
| 3 | $25,820 | $56,840 |
| 4 | $31,200 | $68,640 |
| 5 | $36,580 | $80,476 |
| 6 | $41,960 | $92,312 |
| 7 | $47,340 | $104,148 |
| 8 | $52,720 | $115,984 |
| Additional | Add $5,380 for each extra person |
Need a Financial Hardship Form?
As a referring provider, you can use the Financial Hardship Form to collect financial information from a potential iTASC patient. It is for your internal office use only.
Does a patient qualify for MOHS surgery?
Mohs micrographic surgery involves step-by-step removal of cancerous tissue in the layers. Each layer is examined under a microscope in real time. It is effective for cancers in cosmetically or functionally sensitive areas, and for recurrent or aggressive tumors.
Use the Mohs AUC App to determine if your patient qualifies for surgery.
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The patient must meet the Mohs AUC criteria of a 7,8 or 9 to qualify.