Get 11 Eea Application Form 04 16 Finaldocx

This guide provides clear and accessible instructions on how to complete the 11 EEA Application Form 04 16 FINALdocx online. It breaks down each section of the form to help users submit their application accurately and efficiently.

Follow the steps to complete the 11 EEA application form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editing interface.
2. In Part 1, select your application route for treatment by ticking only one box to indicate whether you are applying before or after treatment, and specify if it is through the S2 route or not.
3. In Part 2, provide your personal details clearly in BLOCK CAPITALS. This includes your family name, first name(s), date of birth, sex, contact information, NHS number, and your permanent address in England.
4. For Part 3, confirm your residency status. Tick the relevant boxes to affirm that you are ordinarily resident in England and provide details of any current residence if it differs from your settled address.
5. Part 4 requires you to list details of the treating clinician and healthcare establishment in the EEA where treatment was or will be received.
6. In Part 5, answer questions regarding treatment details. Specify if you have applied for treatment before, whether it was emergency treatment, and provide a description of your diagnosed medical condition.
7. Part 6 asks for any prior treatment history and previous funding applications related to your condition. Provide any necessary additional details.
8. Complete Part 7 by including supporting relevant information, and provide additional sheets if needed.
9. In Part 8, document post-treatment costs. Record each treatment with receipts and proof of payment in the specified format.
10. Part 9 involves declaring the accuracy of the information provided and consenting to information disclosure. Sign and date as the patient.
11. If applicable, complete Parts 10, 11, and 12 to confirm the applicant's details if they differ from the patient. Ensure all declarations are signed.
12. Review Part 13 and complete the application checklist to ensure all necessary documents are included and that the application is complete.
13. Finally, submit your application form and accompanying documents to the specified address or email.

Complete and submit your 11 EEA Application Form 04 16 FINALdocx online today.