Hd1 form 2026

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The document is a GMS (Hardship) Assistance Application form that requires completion by both the patient and healthcare professionals. Section A is filled out by the patient, providing personal information and consent for the Health Services Executive (HSE) to assess their eligibility for free prescription items. Section B is completed by a doctor and pharmacist, certifying the patient's need for specific medications not covered under standard reimbursement. The form must be submitted to the local HSE office for approval.

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Click ‘Get Form’ to open the hd1 form in the editor.
In Section A, enter your First Name, Surname, and Address. Ensure all details are accurate for proper processing.
Fill in your Medical Card Number and its Expiry Date. Include your PPSN, which can be found on official documents like your Tax Cert or payslip.
Sign and date the application in Section A to confirm your request for assistance with drug costs.
Move to Section B, where your Doctor will certify your treatment needs. Ensure they complete all required fields regarding the items needed.
The Pharmacist will then price the items and provide their signature along with a stamp for verification.
Once completed, submit the form to your HSE Local Health Office as instructed.

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Versions	Form popularity	Fillable & printable
2017	4.4 Satisfied (56 Votes)

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