Hse Medical Card And Gp Visit Card Application Form
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12Medical Card and GP Visit Card Form MC1 1
Medical Card and GP Visit Card
Application Form
MC1
Who should use this form?
Anyone applying for either a Medical Card or a GP Visit Card – you will be assessed for both.
How do I apply for a Medical Card or a GP Visit Card?
Step 1. Complete this form. Read this page and the next page for help.
Step 2. Include all the documents we ask for in Part 3 and Part 4. Please send photocopies only.
Step 3. Read and sign the declaration in Part 5.
Step 4. Ask your doctor of choice to complete Part 6A and, if appropriate, ask your spouse’s or partner’s doctor
to complete Part 7A.
Step 5. Read and tick the checklist on page 12.
Step 6. Send the completed application form and copies of all the documents we ask for, to:
Client Registration Unit, PO Box 11745, Dublin 11.
What can I do to avoid delaying the process?
If you send us a fully completed form and all the documents we ask for, we will deal with your application quickly
and will let you know within 15 working days if you are entitled to a card. So to avoid delay, ensure to do the
following:
•
take care to fill in all your details correctly,
•
include copies of all the documents we ask for in Part 3 and Part 4, and
•
make sure the documents you send us are up to date.
If you do not include all the information we ask for, we will have to write to you for the missing information.
Need help?
Read this page and the next page for help. If you need further help completing this form, phone
Callsave 1890 252 919 or visit your Community Health Organisation.
MC1 May 2015
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Parent category: Medical