Illness Benefit Request — Deerpark Medical Centre Ashbourne GP

Illness Benefit Certification

If you are out of work more than 5 days due to illness then you are entitled to Illness Benefit as part of your P.R.S.I taxes

You MUST HAVE BEEN SEEN by your GP to get a Cert

Those seeking Certification who have not seen the GP will be called in for appointment.

To apply for this benefit you need to fill in application form IB1 (available online)

You must also request a Medical Certificate of Illness (Med 1 form) from your GP.

The e-Cert is sent electronically to the Department by your GP.

You can request the Med 1 certificate using the form below.

NB: Certs will only be issued following an initial review by your GP.

Note:

The E-Cert sent covers the totality of the illness and no ‘First, Middle or Final' cert is sent

Name

First Name

Last Name

Date of Birth

(dd/mm/yy)

PPS Number

A Certificate can not be completed without the correct number

Mobile Phone

Which type of Cert?

Med 1 (applies to most Illnesses) Med 2 (ONLY CHOOSE IF YOU HAVE LETTER FROM DEPARTMENT INSTRUCTING YOU TO APPLY FOR MED2 INSTEAD OF MED1)

Med 1

Med 2 - 4 weeks

Med 2 - 13 weeks

Med 2 - 26 weeks

Dates Cert applied for

Note: Certificate duration is a function of the claimant's illness, the Department's guidelines for expected length of absence and the GP's clinical judgement. Above dates are indicative. They are not the definitive dates.

Illness causing abscence

Short description.

Consent for E-Cert

I consent to the electronic transmission of my data by the GP to the Department of Employment and Social Protection

I Agree

Correct form chosen? Wrong form affects payment

Please check you have chosen the correct Med1 or Med2 option. READ the conditions for choosing Med2 and change if wrong type chosen.

I have chosen correct type