For Irish private rooms
The forms, explained
Each form stays its issuer’s. These pages say what it asks for, who completes which part, and where it goes, with a document in Brigid stationery to go beside it. Our own letters and consents are in the template library.
Vhi Healthcare
- Vhi pre-authorisation requestSome Vhi-covered procedures need prior approval, and the request comes from the consultant, in writing.
- Vhi consultant registration formBefore Vhi pays for your work, you register as a provider; the form comes with a document checklist that decides how long it takes.
- Vhi hospital claim formThe in-patient and day-case claim form Vhi settles directly with the hospital; the admitting consultant owns six of its eleven sections.
- Vhi PVS (Patient Verification System) registrationThe Vhi portal where practice staff look up a patient's level of cover and benefits before a procedure or a claim. Registration is online and needs a phone for multi-factor authentication.
Irish Life Health
- Irish Life Health consultant registrationIrish Life Health pays registered consultants only; registration is a form, a CV and your hospital contract, by email.
- Irish Life Health hospital claim formThe hospital supplies the Irish Life Health claim form; the consultant's part is the clinical section and the procedure code the patient needs to check cover.
- Irish Life Health pre-authorisation requestCertain procedures are only covered when Irish Life Health approves them in advance; the health care provider asks in writing and hears back within 15 working days.
Level Health
- Level Health pre-authorisation requestLevel Health takes pre-authorisation requests through its provider portal or by email, and PET-CT scans need their own form.
- Level Health consultant registrationLevel Health registers consultants through an online application; approval usually takes about a week and arrives by email.
- Level Health hospital claim formWhere Level Health pays the hospital directly, this form carries the admission; the consultant completes the clinical and procedure sections and signs with a Level Health doctor code.
Laya Healthcare
- Laya Healthcare hospital claim formLaya settles most hospital stays directly: the patient signs a form on arrival and on leaving, and the hospital deals with Laya.
- Laya Healthcare pre-authorisation requestWhere Laya's Schedule of Benefits says a procedure needs pre-authorisation, the consultant asks for it in writing before the admission.
Injuries Resolution Board (PIAB)
National Driver Licence Service
Department of Social Protection
- Illness Benefit certificate of incapacity for workIllness Benefit needs a doctor's certificate from the first day; the GP sends it electronically, and a consultant's out-patient or in-patient certificate counts within limits.
- Disability Allowance medical report (DAMed1)The DA1 application carries a medical report, DAMed1, that the patient's doctor completes and that should travel with any specialist reports the practice holds.
- Carer's medical report (CARMed1)Carer's Allowance, Carer's Benefit and the Carer's Support Grant share one medical report, completed by the doctor of the person who needs care.
- Domiciliary Care Allowance medical report (DCAMed1)Domiciliary Care Allowance needs a medical report on the child, completed by the GP or the specialist, and sent with the DomCare1 application.