Apply by post for a Medical Card or GP Visit Card (Form MC1)

This topic helps you fill in the MC1. Medical Card and GP Visit Card Application Form.

Use this topic if you or someone you support:

• Want to apply by post using the paper MC1 form, and
• Prefer to work through the questions part by part with plain-language guidance

If you are not sure this is the right route, you can go back to:

• Find the right way to apply for a Medical Card or GP Visit Card, or
• Apply online for a Medical Card or GP Visit Card

Note

This page offers plain language guidance. It is not a legal document. Only the Health Service Executive (HSE) can make an official decision about a medical card or GP visit card.

Before you begin

The MC1 form has 8 parts.
You will not need every part, but you must complete all parts that apply to you and your household.

Open each step below to see:

• Who completes that part
• What each field or question is asking for
• Any extra actions or documents you may need

Steps

Step 1. Fill in Part 1 – Declaration and consent

Almost everyone must complete Part 1.
This section is about your consent and responsibility for the information on the form.

Your declaration

Read the statements carefully. They cover things like:

• You live in Ireland and intend to stay for at least a year (“ordinarily resident”)
• You are applying for a Medical Card and/or GP Visit Card
• The information you give is true and complete to the best of your knowledge
• The HSE may check information with other state bodies (for example, the Department of Social Protection or Revenue)
• The HSE may contact your GP or other health professionals involved in your care, if needed, to assess your application
• You agree to tell the HSE if your circumstances or address change

Only sign Part 1 if these statements are correct for you.

Signature and date

You will see spaces for:

• Your signature or mark
• The date (day, month, year)

If you cannot sign your name:

• Make a clear mark in the signature box, and
• Ask someone to witness your mark in the space provided (if the form gives one)

Before you move on:

• Check that you have signed and dated this section
• Make sure anyone else who must sign (for example, a joint applicant if shown on the form) has also signed

Step 2. Fill in Part 2 – Personal details

Most people will complete Part 2.
It collects details about you, and where relevant, about your spouse or partner.

Section A. About you (the main applicant)

The form asks for:

• First name(s) – write all your given names clearly in capital letters
• Surname – your current family name in capital letters
• Birth surname – only if it is different from your current surname
• PPS number – copy this carefully from your Public Services Card or Revenue / DSP letter
• Date of birth – fill in day, month and year in the boxes
• Gender – usually tick one box (for example, male or female)
• Nationality or country of birth if requested on your version of the form

You are then asked about your address and contact details:

• Home address in Ireland – write one line per row and include your Eircode if you know it
• Mobile phone and/or daytime phone – give numbers where the HSE can contact you or leave a message
• Email address – write it clearly. If you do not use email, you can leave this blank

Next there are questions about where and how you live:

• How long you have lived in Ireland – for example, more than or less than one year
• Whether you are “ordinarily resident” (living here now and intending to stay for at least a year)
• Whether you live alone or live with other people
• If you do not live alone, the form may ask you to say who lives with you (for example, spouse/partner, children, other relatives)

Finally, the form asks about your marital or relationship status:

• Tick the box that best describes you (for example, single, married, cohabiting, in a civil partnership, widowed, separated or divorced)

Section B. Existing Medical Card or GP Visit Card

You are asked whether:

• You currently have a Medical Card or GP Visit Card, or
• You ever had one in the past

If you tick Yes, you may be asked to:

• Tick which type of card you have (Medical Card, GP Visit Card or both)
• Write the card number or Medical Card / GPVC number in the box provided

Note

The HSE uses this information to decide whether to renew, replace or extend your existing card.

Section C. Details for your spouse or partner

Complete this part only if you are married, in a civil partnership, or living with a spouse or partner and they are part of this application.

You will usually see the same fields as for you:

• First name(s) and surname
• PPS number
• Birth surname (if different)
• Date of birth
• Gender

The form may also ask for:

• Whether your spouse or partner has, or ever had, a Medical Card or GP Visit Card
• Their card number, if they have one

Note

The HSE uses this information to decide whether to renew, replace or extend your existing card.

Before you move on:

• Check that all personal details are clear and complete for you and, if relevant, your spouse or partner
• Make sure PPS numbers and dates of birth are copied carefully

Step 3. Fill in Part 3 – Your dependent children (if any)

Complete Part 3 if you have children or dependants under 25 who are part of your household and whom you want included on the application.

The form usually gives a table with one row per child.

For each child or dependant, you are asked for:

• First name(s)
• Surname
• PPS number
• Gender
• Date of birth
• Relationship to you – for example, son, daughter, step-child or other dependant
• Whether they are in school, college, training or other education
• Whether they receive a third-level grant or maintenance grant, if this is asked on your version of the form

If you have more children than there are rows:

• Use a separate sheet with the same headings, or
• Ask your local Citizens Information Centre to help you attach an extra list

Before you move on:

• Check that every child you want covered by the card is listed and fully completed

Step 4. Fill in Part 4 – EU or UK rights to health services (if this might apply)

Complete Part 4 if there is any chance that EU or UK rules affect your health-care cover.
This part is important for people who:

• Work, or used to work, in another EU/EEA country, Switzerland or the UK, or
• Have a spouse, partner or parent insured in another EU/EEA country, Switzerland or the UK
• Receive a state pension from another EU/EEA country, Switzerland or the UK
• May be classed as a frontier worker. A frontier worker is someone who lives in Ireland but works across the border in another EU or EEA country, Switzerland or the UK”

You will typically see a small set of Yes/No questions, for example:

• Are you insured for health services in another EU or EEA country, Switzerland or the UK?
• Is your spouse or partner insured there?
• Are you, your spouse/partner or your parent a frontier worker?
• Are you or your dependants getting a state pension from another EU/EEA country, Switzerland or the UK?

If you tick Yes to any question:

• The form may ask for more details, such as the country, your insurance or pension number, or the type of pension
• You may later be asked to complete additional EU forms (for example, S-forms) or to supply documents from the other country

If you are unsure how to answer:

• Make your best attempt, and
• Note any questions to bring to Citizens Information or your local HSE office before posting the form.

Note

You can leave this part and come back after you have spoken to Citizens Information or your local HSE office.

Step 5. Fill in Part 5 – Income details

Part 5 is about all income that you and your spouse or partner receive.
Fill in every section that applies to you. Leave a section blank only if it clearly does not apply.

For each row on the form you will usually see spaces for:

• Amount
• How often it is paid. weekly, fortnightly or monthly
• Who pays it or what the income is from
• A box to tick for Evidence enclosed

A. Social Welfare Payment

Use this section if you or your spouse or partner get a social welfare payment.

In the table, fill in for each payment:

• The amount
• How often it is paid. weekly, fortnightly or monthly
• The name of the payment
• Tick the Evidence enclosed box when you add proof

You must also send evidence. for example:

• A letter from your employer confirming that you are not getting paid by them if you are on sick leave, carer’s leave or maternity leave
• If your or your spouse’s or partner’s employment ended after 1 January 2019, a printout from Revenue “myAccount” showing the details of that employment
• If you are still being paid by an employer, a photocopy of your most recent payslip for each job

B. Wages

Use this section if you or your spouse or partner get wages from an employer.

For each job, fill in:

• The wage amount after tax, PRSI and USC are taken off
• How often you are paid. weekly, fortnightly or monthly
• The employer’s name
• Tick Evidence enclosed when you attach proof

You must send:

• A photocopy of your most recent payslip for each job
• If employment ended after 1 January 2019, the form explains that you can print the details from Revenue “myAccount” and send those instead of a payslip

C. Back to employment or education scheme

Use this section if you or your spouse or partner are on a back to work or education scheme, for example a Community Employment Scheme.

For each person on a scheme, fill in:

• The scheme type
• The start date
• The expected finish date
• Tick Evidence enclosed when you add proof

You must send:

• A letter from the scheme supervisor showing the start date and expected finish date
• A photocopy of your most recent payslip from the scheme, dated within the last 3 months

D. Self-employed

Use this section if you or your spouse or partner are self-employed.

For each person, fill in:

• The amount of income from self-employment
• The type of employment or business
• Tick Evidence enclosed when you attach proof

You must send the evidence requested on your version of the form. This can include, for example:

• All pages of your most recent Notice of Assessment or Acknowledgement of Self-Assessment from Revenue
• A copy of your most recent Income Tax Return (Form 11) if it is not already included
• A set of accounts signed off by your accountant
• A means assessment done by the Department of Social Protection
• A Statement of Liability that lists your self-employment income
• If your business is open less than one year, a first set of accounts
• If your business has recently stopped trading, the date it ceased

E. A social security pension from another state

Use this section if you or your spouse or partner receive a pension from another country.

For each pension, fill in:

• The amount
• How often it is paid. weekly, fortnightly or monthly
• The country that pays the pension
• Tick Evidence enclosed when you attach proof

You must send:

• A photocopy of your most recent payslip, dated in the last 3 months, or
• A letter from the state authority that pays the pension, showing the amount paid within the last 12 months

F. A private or occupational pension

Use this section if you or your spouse or partner get a private or occupational pension.

For each pension, fill in:

• The amount after tax, PRSI and USC are deducted
• How often it is paid. weekly, fortnightly or monthly
• The pension provider’s name
• Tick Evidence enclosed when you attach proof

You must send one of the evidence types listed on the form. for example:

• A photocopy of your most recent pension payslip dated within the last 12 months, or
• A copy of your latest employment details summary printed from Revenue “myAccount”, or
• A letter from the pension provider confirming that the pension is no longer being paid and, if it was paid as a lump sum, the amount of the lump sum

G. Maintenance payment

Use this section if you or your spouse or partner receive a maintenance payment.

For each maintenance payment, fill in:

• The amount
• How often it is paid. weekly, fortnightly or monthly
• The source of the income. for example, the person who pays it
• Tick Evidence enclosed when you attach proof

You must send evidence that is one of the options listed on the form. for example:

• A current court order or maintenance agreement. if it is older than 12 months, you must also send recent proof of payment, such as a bank statement from the last 3 months
• A signed letter from the person who pays maintenance, giving the amount and how often it is paid, dated within the last 3 months
• A recent bank statement dated within the last 3 months, showing three or more maintenance payments in at least 3 months in a row and clearly marked as maintenance

H. Savings and investments

Use this section if you or your spouse or partner have savings or investments. for example, in a bank, credit union, building society or other financial institution.

For each account or investment, fill in:

• The current value of savings or shares
• The name and address of the financial institution
• The type of savings or investment. for example, deposit account, shares or bonds
• Tick Evidence enclosed when you attach proof

You must send evidence of your savings and investments as set out on the form. for example:

• Recent statements for all accounts that show the current balance, or
• Certificates of interest for accounts, or
• Share certificates if you hold stocks or shares

If you do not have enough room, the form explains that you can write extra details on a separate sheet and attach it.

I. Property additional to the family home

Use this section if you or your spouse or partner own any property or land other than the home you live in, including land you do not use yourself.

In the table, fill in for each property:

• The full address of the property or land
• Details of the property. for example, number of bedrooms, number of acres, or note that it is a commercial unit
• The yearly income or value of the property or land
• Any yearly costs. for example, mortgage or other housing related costs
• Tick Evidence enclosed when you attach proof

You must send documents such as:

• A current tenancy agreement and a recent bank statement (dated within the last 3 months) showing three or more rental payments in a row if the property is rented out, or
• A valuation form from a certified auctioneer if the property is not currently rented
• Evidence of any costs linked to the property, for example mortgage statements or mortgage protection bills

J. Any other income

Use this section if you or your spouse or partner have any other kind of income that is not covered in A to I.

For each type of income, fill in:

• The amount
• How often it is paid. weekly, fortnightly or monthly
• The source of income
• Tick Evidence enclosed when you attach proof

You must send evidence of this income. for example:

• A recent letter from the income provider, or
• A bank statement dated within the last 3 months showing three or more payments in a row and clearly showing whose account it is

Before you move on from Part 5

• Check that every income source for you and your spouse or partner is listed in at least one section
• Make sure the amounts and payment frequencies match the payslips, letters and bank statements you are sending
• Tick Evidence enclosed for every row where you have attached documents

Step 6. Fill in Part 6 – Household expenses

Part 6 looks at regular expenses that can affect your means assessment.

The form usually includes headings such as:

• Housing costs – for example, rent, mortgage payments or local authority rent
• Nursing home or long-term care fees, if this applies
• Other necessary medical or care expenses not met by other schemes
• Childcare or care costs where relevant

For each type of expense, you may be asked to:

• Write a brief description (for example, “Rent for family home”)
• Give the amount you pay
• Say how often you pay it (weekly, monthly, annually)
• Attach proof, such as rent receipts, mortgage statements or care invoices

Use the free-text boxes to explain anything that is unusual or hard to capture in the standard questions.

Before you move on:

• Make sure all major, regular expenses are listed, especially those that put significant pressure on your budget

Step 7. Fill in Part 7 – Your doctor (GP)

In Part 7, you choose the GP or medical practice you want your card linked to.

The form normally asks for:

• Name of the doctor or medical centre
• Address of the practice
• Any doctor code or practice number, if you know it

There is usually a space for the doctor’s acceptance. In many cases:

• The doctor or their representative signs and stamps this part to confirm they agree to have you (and any listed dependants) on their panel.

What you can do:

• Check first that the GP is accepting new Medical Card patients, if possible
• Bring the form to the GP practice and ask them to complete the doctor acceptance section before you post it

Tip

If your usual GP is not taking Medical Card patients, you may need to phone another.

Step 8. Read Part 8 – Data protection statement and final checks

The final part of the form explains how the HSE:

• Uses your personal data to assess your application
• May share and check information with other public bodies where the law allows
• Keeps your information secure and up to date

You normally do not have to write anything in this section, but it is important to read it so you understand:

• Your rights (for example, to access or correct your data), and
• Who to contact if you have questions about data protection

At the end of the form, you will usually see a checklist or notes about supporting documents. Use this as a final review before posting.

Where to send the completed form

Before you send

When all relevant parts are filled in, quickly check that:

1. Every section that applies to you has been completed
2. All supporting documents mentioned in the form are attached
3. You have signed the declaration in Part 1
4. Your GP has completed the doctor acceptance section in Part 7, if required
5. You have kept a copy or clear photos of the form and key documents, if you can

PCRS is the Primary Care Reimbursement Service.

Send your completed and signed form, along with photocopies of the evidence needed, to:

Eligibility Unit
PO Box 11745
Dublin 11

You can also email your application instead of posting it.

You can take photographs or scans of each page of your application and email them with your supporting documents to PCRS.Applications@hse.ie.

When you do this, make sure:

1. The photo or scan is not blurry
2. The full page is captured and all figures and details are visible
3. You include the supporting documentation in the email to PCRS.Applications@hse.ie

The PCRS team will then process your application as quickly as they can.

If you need help to complete the form, you or a support person can:

• Bring the form to a Citizens Information Centre or another trusted local service, and ask staff to go through it with you, or
• Contact the HSE Primary Care Reimbursement Service (PCRS) using the contact details on the form

What to do next

• Wait for the HSE to assess your application.
• Keep an eye out for letters, emails or messages asking for extra documents or clarifications.
• If you move house, or if your income or household changes significantly, tell the HSE using the contact details on the form.

Related topics

• Check if you can get a Medical Card or GP Visit Card
• Other ways you might qualify for a Medical Card or GP Visit Card
• Apply online for a Medical Card or GP Visit Card