Myalgic Enceohalomyelitis/Chronic Fatigue Syndrome Application Form

vnd.openxmlformats-officedocument.wordprocessingml.document File
File type: DOCX
File size: 494 KB
Description: Please complete this form if your patient meets the criteria set out within the policy

If your patient falls within the Criteria Based Access element of the policy and the patient demonstrably meets the specific criteria for treatment, the patient can be referred directly via the appropriate Referral Service with the completed referral form.