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Terms of the Scheme

Details of the terms of the Surgical Symphysiotomy Payment Scheme and application forms are contained in the attached PDF file. Word versions of the application forms for each of the 4 Categories A - D, the Authority and Consent Form (FORM 2) and the Deed of Waiver and Indemnity (SCHEDULE1) are also attached.

Terms of The Surgical Symphysiotomy Payment Scheme - 10 Nov 2014

Form 1A - Surgical Symphysiotomy

Form 1B - Surgical Symphysiotomy with Significant Disability

Form 1C - Surgical Symphysiotomy immediately after Caesarean Section

Form P1 - Pubiotomy

Form P2 - Pubiotomy with Significant Disability

FORM 2 - Authority and Consent

SCHEDULE 1- Deed of Waiver and Indemnity

From Monday 10 November at 10.00 a.m. the terms of the Surgical Symphysiotomy Payment Scheme, and application forms may also be obtained in the following ways:

(a) phoning the Office of the Assessor for the Scheme at (01) 6778553 or (01) 6778554 or (01) 6778555; or

(b) writing to the Assessor at The Symphysiotomy Payment Scheme, P.O. Box 12487, Dublin 1; or

(c) collection from the Reception Desk, Department of Health, Hawkins House, Dublin 2

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