INTERNATIONAL PATIENT APPLICATION Dear International Patient in Order for a Patient to Be Considered for Treatment Management at Form

Understanding the UHN International Application

The UHN International Application is designed for patients seeking treatment at the University Health Network. This application is essential for initiating the process of care management for international patients. It ensures that all necessary information is collected to facilitate a smooth transition into the healthcare system. Patients must complete the application accurately to be considered for treatment.

Steps to Complete the UHN International Application

Completing the UHN International Application involves several key steps:

• Gather all required personal and medical information, including identification documents and medical history.
• Fill out the application form thoroughly, ensuring that all sections are completed.
• Review the application for accuracy and completeness.
• Email the completed form to the International Patient Program at ipp@uhn.ca.

Ensuring that each step is followed carefully will help avoid delays in processing your application.

Key Elements of the UHN International Application

The UHN International Application includes several critical components that must be addressed:

• Personal Information: Full name, date of birth, and contact details.
• Medical History: Previous treatments, current medications, and any relevant health conditions.
• Insurance Information: Details regarding health insurance coverage, if applicable.
• Emergency Contact: Name and contact information of a person to reach in case of emergencies.

Providing complete and accurate information in these sections is vital for the evaluation of your application.

Legal Use of the UHN International Application

The UHN International Application is a legally binding document once submitted. It is crucial to ensure that all information provided is truthful and accurate. Misrepresentation or falsification of information can lead to legal consequences and may affect your eligibility for treatment. The application is governed by healthcare regulations and privacy laws that protect patient information.

Eligibility Criteria for the UHN International Application

To be eligible for consideration through the UHN International Application, patients must meet specific criteria:

• Be seeking medical treatment that is not available in their home country.
• Provide all required documentation as part of the application process.
• Have a valid passport and any necessary travel documents.

Meeting these criteria is essential for a successful application and subsequent treatment at the University Health Network.

Form Submission Methods for the UHN International Application

The completed UHN International Application can be submitted through various methods:

• Email: The preferred method is to send the application via email to the International Patient Program.
• Mail: Alternatively, patients can mail the application to the designated address provided by the program.
• In-Person: Patients may also choose to deliver the application in person, if feasible.

Each submission method has its timelines and considerations, so patients should choose the one that best fits their situation.