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Get Fp17r 11
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How to fill out the Fp17r 11 online
The Fp17r 11 form is essential for claiming a refund for a replacement NHS dental appliance. This guide provides clear, step-by-step instructions on how to complete the form efficiently and accurately online.
Follow the steps to complete the Fp17r 11 refund claim form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Complete Part A by entering the patient's details. Fill out the surname, forename, date of birth, and gender using block capitals. Ensure that the address and postcode are accurate for communication purposes.
- In Part B, indicate the bank account details for the refund payment. This includes the account holder's name(s), bank name, sort code, and account number. If applicable, provide the building society roll or reference number. If the patient does not have a bank account, tick the designated box.
- Part C must be filled out by the dentist. Enter the provider's name, address, and location number as required.
- In Part D, record the date the appliance was provided and the date the charge was paid. State the exact charge amount and ensure to attach the necessary receipt.
- Part E requires a detailed description of how the appliance was taken care of prior to being lost or damaged, along with an explanation of how the damage or loss occurred.
- Complete Part F, confirming that the appliance was not lost due to lack of reasonable care by the patient or their guardian.
- In Part G, detail any financial hardships caused by the charge. Provide information about any benefits received as proof, including the relevant certificates or personal status.
- Provide the necessary details for all relevant benefits, including names, dates of birth, and National Insurance numbers for individuals receiving these benefits.
- Once all sections are complete, review the form for accuracy before saving any changes. You may then download, print, or share the completed form as needed.
Start your refund claim by filling out the Fp17r 11 online today.
Yes, you can receive new retainers on the NHS if you meet specific criteria. Your dentist will assess your need for retainers after evaluating your orthodontic treatment. Once approved, they will help complete the FP17R 11 paperwork, which outlines your eligibility and coverage. This service allows you to maintain your dental health without excessive costs.
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