Get Application For Northern Health Travel Grant

This guide provides a clear and supportive roadmap for completing the Application For Northern Health Travel Grant online. By following these steps, you can ensure that your application is filled out accurately and submitted efficiently.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully read through the instructions provided to understand the eligibility requirements and documentation needed. Ensure that you have all necessary information prepared before starting to fill out the form.
3. Begin with Section 1, completing it with the patient’s information. This includes the patient's full name, health number, date of birth, and contact details. If the patient is under 16, a guardian must fill this section.
4. Move to Section 2, which needs to be filled out and signed by an approved third-party agency, along with the patient’s or guardian's signature.
5. Complete Section 3 with details from the northern referring provider. This section must be completed before travel occurs to confirm that the referral is medically necessary.
6. In Section 4, input the details provided by the specialist. This includes the date of treatment and type of service provided, ensuring it is an insured service.
7. If applying for a companion grant, fill out Section 5, providing necessary details about the companion and their relationship to the patient.
8. Before submitting your application, review each section to ensure all fields are filled out correctly and signatures are included where required.
9. Gather and attach original tickets or receipts for any transportation used as stipulated in the general instructions.
10. After confirming everything is accurate, save your changes and download the completed application form. You can also print it out to submit physically.

Start filling out your Application For Northern Health Travel Grant online today to ensure you receive the assistance you need.