Funding For Treatment In The European Economic Area (Eea) Application Form Page 7
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10h)
What treatments (if any) are you already receiving / have received, for this
condition, and please indicate if any are / were on the NHS?
i)
Have you applied for funding, via the NHS, for this treatment before?
Applied for funding:
Yes
No
Funding approved:
Yes
No
If Yes, provide further details, including dates / reference numbers (previous EU
reference number or other NHS reference number):
_______________________________________________
Details:
If No, provide the reason why funding was not approved:
Is the application in relation to emergency / urgent (unplanned) treatment
j)
abroad?
Yes
No
If Yes, did you try to use your European Health Insurance Card (EHIC)?
Yes
No
Didn’t have an EHIC card
If you tried to use your EHIC card, was it accepted by the provider?
Yes
No
If no, please record the reason below why the provider would not accept it:
Did you have travel insurance?
Yes
No
k)
If yes, please state why you are applying for NHS funding rather than making an
insurance claim.
9a. EEA application form (10 /14)
Page 7 of 10
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