Dpsr1 2026

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The document outlines the process for submitting a refund claim under the Drugs Payment Scheme (DPS) in Ireland, effective from March 1, 2011. It details eligibility requirements, necessary documentation, and procedures for families using multiple GMS contracted pharmacies. The form includes sections for applicant details, refund claim specifics, and a declaration of accuracy. Additionally, it emphasizes data protection compliance under GDPR and provides guidance on where to obtain assistance and submit claims.

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Click ‘Get Form’ to open the dpsr1 in the editor.
In Part 1, enter your Applicant's Details using BLOCK CAPITALS. Fill in your Drugs Payment Scheme Number, PPS Number, and contact information including your address, daytime/mobile phone number, email address, and Eircode.
Move to Part 2 for Refund Claim Details. Specify the month when your family’s payments exceeded the co-payment amount. Indicate if this claim is for a service/item from a supplier other than a GMS contracted pharmacy by ticking 'Yes' or 'No'. If 'Yes', provide the supplier's name.
List each family member's DPS number who paid during that month. For each entry, include the GMS Contracted Pharmacy Number, date dispensed, and confirm that you have attached the receipt.
In Part 3, read the declaration carefully. Ensure all details are accurate before signing and dating the form.

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2011	4.3 Satisfied (28 Votes)

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dpsr1

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