DA006 – Transmission of Request for Authorisation to receive scheduled treatment in a Member State other than the Competent Member State and the Member State of Residence

(1)

Purpose of the SED:

This SED is a transmission of a request for authorisation to receive a scheduled treatment in a Member State other than the Competent Member State and the Member State of Residence;

 this is a request from insured person residing outside of the competent Member State to receive authorization for scheduled treatment forwarded by the Member State of residence;

 Request for scheduled treatment on DA006 applies only for the benefits in kind related to an accident at work or an occupational disease;

 The institution of the place of residence which forwards the request on DA006 is obliged to certify in a statement that the person can / cannot be treated within a medically justifiable time limit in the Member State of residence, as it is a basis for granting the authorization.

For general remarks applicable to all the AWOD SEDs click here.

DA006 could be used when:

 An insured person, who resides in a Member State other than the competent Members State, needs treatment that is not available in the Member State of residence in a medically justifiable time limit.

Data required:

Specific mandatory fields in DA006 (without which SED should not be send):

 5.1 “requested treatment” – with a:

o description of a treatment for which an authorisation is requested,

o date on which the person submitted a request in the institution of the place of residence,

o name and address of the provider of the treatment (outside the Member State of residence),

o hypothetical period of the treatment;

 5.2 “the person can be treated within a medically justifiable time limit in the Member State of residence” – a confirmation that the treatment can / cannot be provided in the Member State of residence with choice between yes/no

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In order to see the content and explanatory notes of SED DA006 please click here .