Application for Patients

It's time for a second opinion.

The Mike Shane Memorial Fund can help.

A grant from the Mike Shane Memorial Fund provides a written remote second opinion for patients on Medicaid who need a second opinion on their diagnosis of Cholangiocarcinoma before embarking on a course of treatment. Remote second opinions will be provided by one of our medical partners.

To apply for this grant, you must meet these eligibility requirements:

  • You have received an initial diagnosis of Cholangiocarcinoma.

  • You are currently enrolled in the Medicaid program.

  • You are not currently - nor will be at the time of consultation - a registered inpatient at any hospital.

  • Having access to a computer or smartphone will be helpful when you receive your second opinion report, or you can receive the report from your primary physician.

Please submit the form to the right to express your interest in applying for this grant (or to nominate a patient). We will be in touch about the next steps in the application process!

If you have any questions, please email us at mikeshanefund@purview.net.

Memorial Sloan Kettering, PinnacleCare and Purview have the right and ability to deny or refuse any request for a second opinion. 

Patient Application Inquiry

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Last Name*

Email*

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The Mike Shane Memorial Fund (MSMF) is tax exempt under Section 501(c)(3). All donations made to MSMF are tax-deductible to the extent allowed by the Internal Revenue Code.

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