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Document What are the exemption categories listed on the patient declaration of a PR / FP17 dental form?

a) I am entitled to free NHS dental services because on the first day of treatment:
  • I am under 18 years of age

  • I am 18 years of age and in full time education

  • I am pregnant

  • I had a baby in the last 12 months

  • I am currently in prison or a young offenders institution
b) I am entitled to free NHS dental services because during the course of treatment I get, or am included in an award (as a claimant, partner, or dependent person under 20) of:
  • Income Support (Incapacity benefit and Disability Living Allowance does NOT count)

  • Income-based Jobseeker's Allowance (Contribution-based does NOT count)

  • Income-related Employment & Support Allowance (Contribution-related does NOT count)

  • Pension Credit Guarantee Credit (Saving Credit on its own does NOT count)

  • Universal Credit (in the last assessment period there were no earnings, or earnings were within the allowed limit, please check at www.nhs.uk/healthcosts)

    THESE ARE THE ONLY BENEFITS THAT ENTITLE YOU TO FREE NHS DENTAL SERVICES
c) I am entitled to free NHS dental services because I am named on one of the following certificates that is valid during the course of treatment:
  • HC2 Certificate

  • NHS Tax Credit Exemption Certificate/Card (or entitled to one)
    (You are not automatically entitled because you receive Tax Credits; there are qualifying conditions, please check www.nhs.uk/healthcosts. If you qualify you will be sent an exemption certificate/card, but if you don't have one you can use the award notice as proof.)
d) I am entitled to reduced cost NHS dental services because:
  • I am named on a HC3 certificate that is valid during the course of treatment which limits the amount I have to pay to £____
Click here to view an example of a PR form.



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