Application Detail
Status
ClosedDescription of Medical Service
-Description of Medical Condition
-Reason for Application
-Medical Service Type
-Previous Application Number
1089Associated Documentation
Application Form
-PICO Confirmation
-Assessment Report
Assessment Report (PDF 2445 KB)Assessment Report - Accessible (Word 4795 KB)
Public Summary Document
One Page Summary (PDF 50 KB)One Page Summary - Accessible (Word 38 KB)
Public Summary Document (PDF 107 KB)
Public Summary Document - Accessible (Word 104 KB)