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Apply for a Medical Card or GP Visit Card if you are aged 70 or over (Form MC1(a))

This topic helps you fill in the MC1(a) Medical Card and GP Visit Card Application Form for people aged 70 years or older and their spouse or partner.

Use this topic if you or someone you support:
  • Are 70 years of age or older and want to apply for a Medical Card or GP Visit Card using the MC1(a) paper form
  • Are a spouse or partner of someone aged 70 or over and are included in the same application
  • Prefer to work through the paper form 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(a) form has 6 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 documents you need to attach

Steps

Step 1. Fill in Part 1 – Your personal details

Most people will complete Part 1.
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.

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 2. Fill in Part 2 – Personal details for your spouse or partner

Complete Part 2 only if you are married, in a civil partnership, or living with a spouse or partner who is part of this application. If you are not, skip to Part 3.

You will usually see the same fields for your spouse or partner as for you:

  • First name(s) and surname
  • PPS number
  • Birth surname (if different)
  • Date of birth
  • Gender
  • “ordinarily resident” (living here now and intending to stay for at least a year)

The form also asks:

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

Before you move on, check that all their details are complete and all boxes that apply are ticked.

Step 3. Fill in Part 3 – Details of income

Part 3 is about all income and assets for you and, if it applies, your spouse or partner.

You complete:

  • A. Your income details
  • B. Your spouse’s or partner’s income details
  • C. Savings and investments
  • D. Property additional to the family home

Use extra paper if you need more space. Always send photocopies of the evidence the form asks for.

Important

  • You may qualify for a Medical Card if your gross income is at or below the income limits for the over-70 scheme
  • You qualify for a GP Visit Card without an income test if you are 70 or over
  • If your income is higher than the limits for this scheme, you may still qualify under the General Medical Card Scheme, which uses Form MC1 instead

A. Your income details

Use this section to list every income source you have.

For each row on the form, write:

  • The amount of the payment
  • How often you receive it - weekly, fortnightly or monthly
  • The name or type of payment
  • Tick the evidence enclosed box when you attach proof

The main income types on the form are:

1. Social Welfare payment

Examples include State Pension, Widow’s or Widower’s Pension, Carer’s Allowance or other DSP payments.

  • Write the amount, how often you are paid and the name of the payment
  • Send a recent post office receipt or bank statement that shows the payment

If you get Illness Benefit and also receive wages, include a letter from your employer that explains what wages you are still being paid.

2. Wages

Use this if you work for an employer.

  • Write the amount after tax, PRSI and USC, how often you are paid and the employer’s name
  • Send a recent payslip for each job

3. Back to employment or education scheme

For example, Community Employment Scheme.

  • Write the scheme type, start date and expected finish date
  • Send a letter from the scheme supervisor that shows these dates and a recent payslip

4. Self-employed income

For example, farming or running a business.

  • Write the amount and type of self-employment
  • Send one of the following:
  • Your most recent Notice of Assessment from Revenue, or
  • Your Statement of Liability and Income Tax Return (Form 11), or
  • A set of accounts signed off by your accountant if that is what Revenue asked for

5. Social security pension from another state

Use this if you receive a state pension from another country.

  • Write the amount, how often you are paid and the country that pays the pension
  • Send a recent payslip or official letter from that country that shows the payment

6. Private or occupational pension

  • Write the amount after tax, PRSI and USC, how often you are paid and the pension provider
  • Send either:
  • A recent pension payslip, or
  • A printout from Revenue myAccount that shows your current pension details, or
  • A letter from the pension provider that explains if a lump sum was paid

7. Maintenance payment

Use this if you receive maintenance from another person.

  • Write the amount, how often it is paid and the source of income
  • Send one of the following:
  • A court order or maintenance agreement plus a recent bank statement, or
  • A signed letter from the person who pays the maintenance, dated within the last 3 months, plus a recent bank statement

8. Any other income

For example, rental income that is not listed elsewhere or income from abroad that does not fit the other headings.

  • Write the amount, how often you are paid and where it comes from
  • Send any documents that clearly show this income

B. Your spouse’s or partner’s income details

This section repeats the same headings as A but for your spouse or partner.

For each income they receive, fill in:

  • The amount
  • How often they are paid
  • The name or type of payment
  • Tick evidence enclosed when you attach proof

Use the same types of evidence as listed under A, but for your spouse or partner.

If you do not have a spouse or partner, you can leave this part blank.

C. Savings and investments held by you or your spouse or partner

This section asks about savings, shares and investments.

First question:

  • Do you or your spouse or partner have investments in stocks, shares or savings with banks, building societies or other financial institutions
  • Tick Yes or No

If you tick No, go to D. Property additional to the family home.

If you tick Yes, complete a row on the table for each account or investment:

  • Current value of savings and shares - the balance or value now
  • Name and address of financial institution where the money is held
  • Type of savings or investments - for example, current account, deposit account, credit union shares, investment fund, shares
  • Tick evidence enclosed when you attach proof

Send photocopies of:

  • Recent statements from the bank, credit union or other institution that show the balance

If you need more space, use a separate sheet and attach it.

D. Property additional to the family home

This part covers any property or land you own that is not the home you live in, including land you do not personally use.

First question:

  • Do you or your spouse or partner own any property or land other than the house you live in, including land not personally used
  • Tick Yes or No

If you tick No, you can move on to Part 4.

If you tick Yes, complete the table for each property or piece of land:

  • Full address of property and land
  • Details of land and property - for example, number of bedrooms, number of acres, shop unit
  • Yearly income or value of the property or land
  • Yearly costs - for example, outstanding mortgage or other regular costs
  • Tick evidence enclosed when you attach proof

Send photocopies such as:

  • Tenancy agreements or bank statements that show rental income
  • Receipts or statements that show mortgage repayments or other related costs

If you run out of space, use another sheet with the same headings and attach it.

Before you move on from Part 3:

  • Check that every income source, savings account and extra property is included where it applies
  • Make sure you have ticked evidence enclosed for each item and attached photocopies
  • Check that amounts and payment frequencies are clear and match your documents
Step 4. Fill in Part 4 – Declaration and consent

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 for yourself and, if it applies, your dependants
  • The information you give is true and complete to the best of your knowledge
  • The HSE may check information with other Government Departments, such as the Department of Social Protection, Revenue Commissioners or Department of Justice, to confirm the information you have given
  • The HSE may contact your GP or other health professionals involved in your care, if needed, to assess your application
  • The HSE may directly contact your nominated contact person (advocate) if you choose to name one
  • You agree to tell the HSE if your circumstances or address change

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

Part 4A – Nominated contact person (advocate)

You may nominate a person to act as your contact person or advocate.

Fill in:

  • Nominated contact person’s name
  • Telephone number
  • Relationship to applicant – for example, son, daughter, friend, advocate
  • Nominated contact person’s address

All correspondence about your application will be sent to this nominated contact person if you provide one.

Part 4B – Mark and signature of witness

Complete this part only if you cannot sign the declaration yourself.

Your witness should:

  • Sign in the Signature of witness box
  • Write the date
  • Write their address in the space provided

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 5. Fill in Part 5 – Doctor of choice

In Part 5, 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 6. Fill in Part 6 – Spouse’s or partner’s doctor of choice (if needed)

Complete Part 6 only if your spouse or partner needs a different doctor of choice.

You fill in:

  • Doctor’s name
  • Doctor’s practice address
  • Will your dependants (if you have any) attend this doctor – tick Yes or No

Then ask that doctor to complete Part 6A – Doctor’s acceptance (for spouse or partner).

Where to send the completed form

Before you send the form

Before posting or emailing your application, quickly check that:

  1. All parts of the form that apply to you have been completed
  2. You have included photocopies of proof of all income and assets declared in Part 3
  3. You have included photocopies of any E or S forms or a letter from the UK Pensions Board if you are applying under EU Regulations
  4. You have read and signed or marked Part 4
  5. Your doctor has completed Part 5A, and if it applies, your spouse’s or partner’s doctor has completed Part 6A

If you have questions before you send the form, phone 0818 224 478 or contact your Local Health Office.

Send your completed form and photocopies of the documents to:

Eligibility Unit
PO Box 11745
Finglas
Dublin 11

Or email scanned copies or clear photos of the full application and documents to:
pcrs.applications@hse.ie

Make sure that:

  1. Each photo or scan is clear and not blurry
  2. The full page is visible with all details
  3. All supporting documents are attached to the same email thread if possible

Keep copies of everything you send in case the HSE needs more details later.

What to do next

  • Wait for the HSE to assess your application.
  • Keep an eye out for letters, texts or emails asking for extra information.
  • If your income or living situation changes after you apply, contact the HSE to let them know.