How do i claim a refund of travel costs paid in northern ireland. Hc1 form is a document to claim for help with health and travel costs. This feedback form is for issues with the nidirect website only. Health help with health costs help with health costs. Payments should be made payable to police service of northern ireland. Complete an hc5 refund form and make sure you enclose your optical prescription and your receipt with your hc5 when you send it off. If you are aged under 16, or under 19 and in fulltime education. Help with health costs nhs voucher schemes patient. More refund details can be found in leaflet hc11 help with health costs available to download at. For prescriptions you must get a receipt at the time you collect the prescription form fp57 in england you cant go back and get one. Ir3 before com pleting this form, ase see instruction below s. Northern ireland to apply for a refund of optical charges paid in northern ireland, you need to complete an hc5 form.
Guidance for the completion of prescribed forms forms 1. To apply for a refund of travel costs paid in northern ireland, you will need to complete an hc5 form. Statutory forms used in compulsory liquidations and proxy. Safelives dash risk checklist quick start guidance. Form of notification of a dangerous occurrence approved under the safety, health and welfare at work general application regulations, 1993 form no. Theres a quick guide to help with health costs on the scottish government website. Healthcare travel costs scheme instructions and guidance for the nhs 2009 27 may 2010 pct ces, nhs trust ces, sha ces, care trust ces, foundation trust ces, directors of finance, communications leads. If you live in northern ireland, download the hc1 form from nidirect. We can only provide advice to people living in northern ireland.
Request for general information not rtc please use this form if you wish to have third party information related to non road traffic collisions released to you. If you are on a low income, then you may be entitled to a refund. Nhs business services authority knowledge base how do. You can claim a refund of your travel costs by filling in form hc5 and giving it to the place you go to for nhs treatment. Completed forms should be submitted to urban region ocmt, psni, 18 lislea drive, belfast bt9 7jg. You may claim help for yourself, your partner, children whenever you need it. In northern ireland you can get a form hc5 from your local social security office. Please ensure you send all the pages of the completed form to us when you make your claim.
Eptica self service where can i get a hc1 hc5 form from. How you obtain hc1 hc5 forms depends on which uk country youre in and whether youre a member of the public or a practitioner. I declare that, to the best of my knowledge and belief, this form contains a correct statement for the purposes of assessment to tax for the year 2018 and a correct statement of capital gains which accrued in the year 2018. Drug tariff part xvi, clause 7 full details of the prescription charge refund procedure can be found in part xvi of the drug tariff. If you require a hc5, click here to download and print off the relevant refund claim form. You can get these hc certificates from your local social security office. Includes charges and optical voucher values october 2017 hcs 2. The first sector is the detailed introduction of the hc1 that insturcts you how to use the form. Hc5t nhs claim form for refund of travel costs issuu. If you are claiming on the grounds of low income, complete form hc5 dental charges pdf you may also be able to get an hc5 from from your dentist, a jobcentre plus office or nhs hospital. If you present your prescription in northern ireland or wales you will not be charged. Prescribed forms forms 1 12 under the mental health ni.
It is also helpful while asking for the cost help for prison visits and expenses connected with this. This form can be used to claim back the cost of nhs dental treatment. Claim form for a refund of nhs dental charges hc5 d summary. We ask about whether the victim is experiencing any form of sexual abuse in question 16. If you have travelled to more than one place, you will need. To order forms hc1 and hc1 sc or request hc1 in large print or other formats or for help to complete a form, call help with health costs helpline. Form 4 21 form 5 26 form 6 27 form 7 30 form 8 34 form 9 39 form 10 43 form 11 48. Hc5 part 4 patients income when the charge or travel costs were paid group 3 group 1 group 4 i have a war pension and i am being treated for my accepted disablement send this form to. Claim for help with health and travel costs form hc1. All prescriptions dispensed in northern ireland are free of charge for everyone. If you qualify for free dental care, sign the form they give you when you go for treatment. This form is to be used by persons resident in wales. Use a separate form for each person who has paid travel costs or has had travel costs paid for them. Eptica self service how do i claim a refund of nhs dental charges.
How to claim a refund health and social care in northern. Nhs dental charges please read this page before filling in this form it will help you make this claim correctly. The nidirect privacy notice applies to any information you send on this feedback form. More refund details can be found in leaflet hc11 help with health costs available to download. Great britain and northern ireland dividends net amount received 301. Most health service treatment is free, although there can be charges for some things. Where can i get an hc1 application form or hc5 refund. Da1 form declaration for health service committed dentists please click here for mds for guidance in relation to completion of da1 form. England click here to download and print off an hc1. Hc5 t claim form for a refund of travel costs to receive nhs treatment please read this page before filling in this form it will help you make this claim correctly. We will retain your address information for no more than a year to monitor trends in how customers order the application form and the number of completed forms we receive. Check the nhs business services authority website to find out how to obtain the form hc5 in england, scotland and wales. Work carefully through this form in most of the form we ask you to tick a no or yes box and give any details needed. All prescriptions dispensed in northern ireland are free of.
Service personnel and veterans agency,norcross, blackpool fy5 3wp. There is a separate hc5 form for each charge, for example hc5 d for dental charges. You can obtain the form in person from your social security office or job and benefits office. Complete and return hc5 form and original receipt if your refund relates to purchase of glasses, include a copy of your optical. In england the eligibility criteria in the first section apply plus. You may be able to get an hc1 form from your gp, dentist or optician. Help with health costs royal medical benevolent fund. The nhs business services authority will share the information that you give with our supplier who then post the forms to you. Free download of form hc1 document available in pdf format. Use these free templates or examples to create the perfect professional document or project. Northern ireland order 1986 mho provide legal justification for staff who take actions under the mho. Medical consent form 5 documents dot physical form 2 documents bsa medical form 3 documents medical application form 4 documents generic authorization medical release form 8 documents immunization record 5 documents medical records request form 8 documents health and safety policy statement 3 documents hc1 form 2 documents. The helpline can provide an interpreter if english is not your first language. Present an english prescription form at a pharmacy in scotland and you qualify under exemption arrangements detailed in the nhs free prescriptions and charges for drugs and appliances scotland regulations 2011.
Statutory forms used in compulsory liquidations and proxy forms for individual and company insolvency. If youre on a low income, you may be able to get help with health service and travel costs. Claim form for a refund of nhs dental charges hc5d. Please ensure you complete and send all of the pages. Northern ireland you need to contact your local social security office to request either a hc1 or hc5. Service personnel and veterans agency, norcross, blackpool fy5 3wp. Completing an advanced notification of redundancies form hr1. If you want to claim a refund, ask the person who supplies your glasses or contact lenses for a receipt which shows how much you paid and the date of payment. Hc5 o part 4 reason for claim group 1 group 4 i have a war pension and i am being treated for my accepted disablement send this form to. The northern ireland 24hour freephone domestic violence helpline 0800 802 1414. Affiliate marketing on the focus on disability website. Although treatment on the nhs is free at the point of delivery, there may still be some costs eg.
Please read the notes on this page and page b before filling in this form they will help you to claim correctly. Download the relevant form by following the link to. You can download and print off an hc1 hc5 from our website. Forms library health and social care in northern ireland. Hc5 refund claim form nhs business services authority. Then pull off pages a and b and keep them for information. However, much or all of the cost can, in some cases be reclaimed, waived or you may be eligible for help under the nhs low income scheme.
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