Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation form (SA449)

Use this form as part of the assessment for Essential Medical Equipment Payment, to cover the additional costs of running essential medical equipment.

Download and complete the Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation form.

Your Medical Practitioner needs to complete this form.

The Medical confirmation form is not a claim for Essential Medical Equipment Payment.

It must be submitted with your claim for Essential Medical Equipment Payment.

Read the information you need to know about your claim for the Essential Medical Equipment Payment.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 10 September 2020