Application Detail
Status
ClosedDescription of Medical Service
-Description of Medical Condition
-Reason for Application
-Medical Service Type
-Previous Application Number
1090Associated Documentation
Application Form
-PICO Confirmation
-Assessment Report
Assessment Report (PDF 1033 KB)Public Summary Document
One Page Summary Report (PDF 20 KB)One Page Summary Report (Word 33 KB)
Public Summary Document (PDF 83 KB)
Public Summary Document (Word 183 KB)