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You have to be registered with a General Practice in NHS ER of Yorkshire CCG to use this service.
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Details of this prescription will be shared with your Doctor and the Local Clinical Commissioning Group for Audit Purposes. All information will be treated with the strictest confidence and held in acordance with the Data Protection Act.
Note: YOU will be asked to show proof that you do not have to pay prescription charges. if you do not have proof, you will still get your free medicine supply but checks will be made later to confirm your eligibility.
DECLARATION: I declare that the information I have given on this form is correct and complete and I understand that if it is not, appropriate action may be taken against me. I confirm proper entitlement to exemption and for the purposes of checking this, I consent to the disclosure of relevant information, including to and by the Inland Revenue and Local Authorities.
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