Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Appendix Two NHS England IFR Application Form and open it in your chosen editor.
2. Begin with Section 1, which requires provider details. Input the name of the provider, the clinician undertaking the intervention, their job title, secure NHS email, and telephone number in the designated fields.
3. Move to Section 2, where you will enter patient and GP details. Fill in the patient's first and last name, NHS number, hospital number, date of birth, age at the time of submission, gender, ethnicity, address, postcode, GP name, practice name, and GP postcode.
4. Proceed to Section 3, requesting details about the treatment. Specify the service type, urgency reasons if applicable, the proposed start and stop dates for treatment, and provide supportive documentation from relevant committees as outlined in the instructions.
5. In Section 4, outline the treatment details, including the primary diagnosis, intervention specifics, existence of clinical policies, and the costs associated with treatment. Also, include anticipated clinical outcomes and any reporting mechanisms you will provide to NHS England.
6. Section 5 covers clinical background. Summarize the patient's clinical situation, treatment history, and any alternative treatments considered, explaining why they are not suitable.
7. In Section 6, describe the clinical exceptionality of the case, providing detailed information about the patient's unique clinical circumstances and how they differ from standard policy guidelines.
8. Complete Section 7 by estimating the incidence and prevalence of the condition, discussing potential future cases, and summarizing the evidence base relevant to the application.
9. Lastly, in Section 8, review the completed form, ensuring all sections are filled out. If satisfied, submit the application to NHS England using the indicated email.

Complete your application and submit the Appendix Two NHS England IFR Application Form online today.