Get D1216

The D1216 form, also known as the treatment service voucher, is essential for documenting services rendered to patients. This guide provides step-by-step instructions on how to fill out the form online, ensuring a smooth and efficient process for all users.

Follow the steps to complete the D1216 online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Complete the Patient Details section by entering the patient’s file number, first name, initial, and surname. If the file number is unknown, provide the patient's date of birth and address.
3. Fill out all relevant sections of the form to ensure completeness.
4. When completing the top section of the D1216 form, the Duplicate and Triplicate copies will automatically populate with the same information.
5. Complete the 'Condition Treated' section only if the patient holds a White card for specific conditions or if the service is emergency-related.
6. If pathology is requested, include a brief description of the requested pathology.
7. Ensure the patient provides all requested information and signs the form. If the patient is unable to sign, the designated person should sign in the appropriate section.
8. For emergency services, remember to cross and sign the specific section designated for emergencies.
9. For manual claiming: Submit the Departmental copy along with any relevant documents, ensuring the patient receives the Patient copy. Retain the Claimant copy for your records. For online claiming, only keep the Claimant copy and any relevant documents for your records.

Start filling out the D1216 online to simplify your document submission process.