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.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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: 3 March 2022