Get Hse Long Term Illness Form

Completing the Hse Long Term Illness Form online is an essential step for individuals seeking benefits under the Long Term Illness Scheme. This guide provides a comprehensive overview of the form's components and offers clear instructions for each section to assist users in completing their applications smoothly.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the Hse Long Term Illness Form and open it in your preferred PDF editor.
2. In Part I, provide your personal information using block capitals, including surname, first name, birth surname, and contact number. Make sure to fill in your complete address and include your mother’s maiden name and date of birth.
3. Enter your Personal Public Service Number (PPSN) in the designated field. Indicate whether you possess a medical card by selecting 'Yes' or 'No,' and if applicable, provide your medical card number.
4. List the name and address of your general practitioner or family doctor, including the name of the hospital or consultant overseeing your care. Additionally, provide the name and address of your pharmacy.
5. If you are under 16 years of age, ensure a parent or guardian signs the form in the section provided. Monitor that all fields are completed accurately and clearly.
6. In Part II, your doctor or consultant will need to complete their section. They must provide their certification of your treatment, detailing the medical condition being treated, the required medical preparations, dosages, and quantities.
7. Ensure your doctor or consultant provides their signature and the date of completion along with their stamp to validate the section properly.
8. After verifying all information for accuracy, you may save your changes, download the completed form, print it for submission, or share it as needed.

Take the first step towards receiving your benefits by completing the Hse Long Term Illness Form online today.