Folder Funding Request Referral Forms
If you are seeking funding for a treatment which is covered by a current Service Restriction Policy and you believe that the patient meets all relevant criteria. Please use form A: Prior approval form.
If you are seeking funding for a treatment which is covered by a current Service Restriction Policy but the patient does not meet the current criteria and you are applying for exceptional funding. Please be aware that it is likely that a group of patient will benefit from the treatment or procedure. Please use form B: Exceptional clinical circumstances form.
If you are seeking funding for a treatment/technology for a medical condition where the CCG has no established commissioning policy and it is likely that your patient will be the only patient within the West Essex CCG requiring this treatment or procedure. Form C: Individual Funding Request form.
Drugs requests only: Please use form D.1 Exceptional clinical circumstances
Please use form D.2 Individual funding request
If you wish to discuss any service restriction policy or funding request please telephone the IFR Coordinators on 01992 566150.