Template Details

Document How should the patient declaration on an FP10 be completed?

Patient has an exemption
Where a patient has exemption from prescription charges they must tick the relevant box in Part 1 of the declaration, they also need to complete Part 3 including a signature.
Where a patient is exempt because they receive income-related Employment and Support Allowance, receive income-based Jobseeker’s allowance, are entitled to NHS Tax Credit exemption or have a partner in receipt of Pension Credit guaranteed credit they should complete the details of the person receiving the benefit in Part 1.
If you do not see the patient’s evidence of exemption you must mark the ‘Evidence not seen’ box on the back of the prescription form with an ‘X’.
Patients who are under 16 or are aged 60 and over are not required to complete exemption if their date of birth is electronically printed on the FP10.

If the declaration is not complete the prescription may be processed as chargeable and the relevant prescription charge(s) deducted from your payment. This is also known as switching or wrong group movement.
Patient pays a prescription charge(s)
Where a patient is not exempt and pay the prescription charge(s) they must complete Parts 2 and 3 of the declaration including a signature.



Contact Us

If this document does not fit your needs, you can contact us. Contact Us