DA007 – Authorisation to receive scheduled treatment in a Member State other than the competent Member State and the Member State of residence
Purpose of the SED:
This SED can be used in two different Business Use Cases, i.e.:
1/ it can be sent as a reply to a request for Authorisation to receive scheduled treatment in a Member State other than the Competent Member State and the Member State of residence (AW_BUC_04a);
2/ it can be sent as a reply to a Information on medically appropriate supplement to authorized scheduled treatment (AW_BUC_04b).
For general remarks applicable to all the AWOD SEDs click here.
• this is the approval or a refusal from the competent Member State for scheduled treatment in a Member State other than the competent Member State and the Member State of residence;
• if the DA007 was sent with the approval the DA007 or portable document issued for person will be the basis for the future request for reimbursement from the competent Member State for the scheduled treatment provided outside the Member State of residence.
Data required:
Specific mandatory fields in DA007 (without which SED cannot be send):
• 5.1 “treatment for which authorisation is requested” with a following details on the treatment which is a subject of the request, i.e.:
o description of the treatment for which a request for authorisation was received,
o name and address of the provider of the treatment (outside the Member State of residence),
o hypothetical period of the treatment;
• 6.1 “Authorisation to receive the treatment described above is hereby:” with a decision whether the authorisation is granted or refused.
o If authorisation was refused than a reason for refusal has to be chosen in 6.2.1 from the list of available choices or if none of the reasons is applicable “other reason” have to be provided in 6.2.2.1.
o Authorisation can be refused if:
o in accordance with the assessment of the institution of the place of residence the treatment can be given within the limit which is medically justifiable taking into account person current state of health and the probable course of illness in the territory of the Member State of the residence;
o the same treatment can be provided in the competent Member State within a time limit which is medically justifiable, taking into account person current state of health and the probable course of the illness.
In order to see the content and explanatory notes of SED DA007 please click here .
