Funding For Treatment In The European Economic Area (Eea) Application Form Page 4
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10Part 4: Treatment Details
(in relation to this application)
a)
What is the DIAGNOSED medical condition for which you have received /
are planning to receive treatment(s) abroad?
b)
Describe the TREATMENT(S) you have received / are planning to receive
abroad.
c)
Is a Clinician’s letter / report attached:
Yes
No
A letter / report must be attached from your Clinician, describing your condition /
diagnosis, and confirming the medical need for the treatment(s). The letter /
report must clearly state why the treatment received will be / was needed.
For S2 applications:
1) The clinician’s letter / report must be from a UK NHS Consultant, on NHS
letterhead, and must support the treatment(s) being carried out in the
proposed country.
2) We also require written confirmation from the provider of: the agreed
treatment(s), treatment dates and estimated costs.
For Directive applications: The letter / report must be from an EEA Clinician
e.g. Consultant / GP (which includes a UK Clinician).
If the letter / report is provided by a Clinician from another EEA country, please
ensure this is in English or that an English translation is provided. You may
provide an accurate translation yourself, but please sign and date.
9a. EEA application form (10 /14)
Page 4 of 10
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