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Haemodialysis and

                                                                             Peritoneal Dialysis
                                                                              – A Guide for Patients



        Tax relief on health expenses



            incurred by kidney patients



                ll patients that pay tax are encouraged to complete a Revenue form Med  The quickest, easiest and most convenient way to claim Health Expenses is by using PAYE Anytime
                                                                                        Form MED 1 +HDOWK ([SHQVHV   &ODLP IRU 5HOLHI
                1 health expenses claim for relief which will relieve the financial burden  Name and Address (include Eircode)
                                                                                        or by submitting an eForm 12.  For further information please visit www.revenue.ie
                somewhat at the standard rate of tax. The form can be downloaded from                PPS Number
        Athe revenue website, or we can do that for you if you would prefer.         FKHFN DQ\ FRUUHVSRQGHQFH \RX KDYH UHFHLYHG IURP 5HYHQXH WR ORFDWH WKH DGGUHVV   \RX KDYH UHFHLYHG IURP 5HYHQXH  ,I \RX DUH PDUULHG RU LQ
                                                                                     Return Address   ,I WKH DGGUHVV RI \RXU 5HYHQXH RI¿FH LV QRW VKRZQ EHORZ  SOHDVH
                                                                                                     7KH 336 QXPEHU FDQ EH REWDLQHG IURP DQ\ FRUUHVSRQGHQFH
                                                                                     QXPEHU LQWR 5HYHQXH¶V FRQWDFW ORFDWRU
                                                                                     WR ZKLFK \RX VKRXOG VXEPLW WKLV IRUP  RU YLVLW www.revenue.ie and enter your PPS
                                                                                                     D FLYLO SDUWQHUVKLS DQG DUH WD[HG XQGHU -RLQW $VVHVVPHQW
           If you are paying €144 per month for your medications for the whole year of               SOHDVH TXRWH WKH 336 QXPEHU RI WKH DVVHVVDEOH VSRXVH RU
                                                                                                     QRPLQDWHG FLYLO SDUWQHU
                                                                                                         Notes
                                                                                                     Please read the notes on Pages 3 & 4 before FRPSOHWLQJ
                                                                                                     WKLV IRUP
        2013 you will be able to claim €1,728.00 on your Med 1 form at 20% standard  Year for which claim is being made
        rate you will be due a €345.60 tax refund. You can make a claim for the previous  by you - See ‘Receipts’ section on Page 3.
                                                                                    Receipts (and Form Med 2 if your claim includes non-routine dental expenses) should not be submitted with this claim but should be retained
        3 years also. In 2012 the Drug Payment Scheme limit was €132.00 and €120.00  1DPH  Individuals for whom you wish to claim
                                                                                    3OHDVH FRPSOHWH LQ DOO FDVHV WKH QDPHV RI WKH SHUVRQV RQ ZKRVH EHKDOI \RX SDLG RU LQFXUUHG KHDOWK H[SHQVHV
                                                                                    $GGUHVV
        for 2011.                                                                   336 1XPEHU
           If, as an individual patient you are not working and do not pay tax, but your  336 1XPEHU  Date of Birth  D D M  M Y Y
                                                                                   Refunds
                                                                                   ,Q WKH FDVH RI D FODLP IRU DQ LQGLYLGXDO ZKRP \RX PDLQWDLQ LQ D QXUVLQJ KRPH  SOHDVH VWDWH WKHLU 336 QXPEHU DQG GDWH RI ELUWK
        spouse is working and paying tax they can make the Med 1 claim for a refund on  (Note  ,W LV TXLFNHU WR UHFHLYH SD\PHQWV HOHFWURQLFDOO\ WKDQ E\ FKHTXH
                                                                                   ,I \RX ZLVK WR KDYH DQ\ UHIXQG SDLG GLUHFWO\ WR \RXU EDQN DFFRXQW  SOHDVH SURYLGH \RXU EDQN DFFRXQW GHWDLOV
                                                                                   Single Euro Payments Area (SEPA)
                                                                                   www.revenue.ie
        their taxes.                                                               International Bank Account Number  ,%$1   0D[LPXP    FKDUDFWHUV
                                                                                   $FFRXQW QXPEHUV DQG VRUW FRGHV KDYH EHHQ UHSODFHG E\ ,QWHUQDWLRQDO %DQN $FFRXQW 1XPEHUV  ,%$1  DQG %DQN ,GHQWL¿HU &RGHV
                                                                                    %,&    7KHVH QXPEHUV DUH JHQHUDOO\ DYDLODEOH RQ \RXU EDQN DFFRXQW VWDWHPHQWV   )XUWKHU LQIRUPDWLRQ RQ 6(3$ FDQ EH IRXQG RQ
                                                                                   ,W LV QRW SRVVLEOH WR PDNH D UHIXQG GLUHFWO\ WR D IRUHLJQ EDQN DFFRXQW WKDW LV QRW D PHPEHU RI 6(3$
        A person on haemodialysis in a hospital or clinic, who does not            %DQN ,GHQWL¿HU &RGH  %,&   0D[LPXP    FKDUDFWHUV
                                                                                   I declare that:  Declaration
                                                                                   1RWH  $Q\ VXEVHTXHQW 5HYHQXH UHIXQGV ZLOO EH PDGH WR WKLV EDQN DFFRXQW XQOHVV RWKHUZLVH QRWL¿HG
        avail of a HSE means of transport and who pays tax may make a               Π, KDYH SDLG DOO H[SHQVHV FODLPHG DQG , KROG UHFHLSWV IRU DOO H[SHQVHV ZKLFK DUH DYDLODEOH IRU LQVSHFWLRQ
                                                                                    ΠDOO SDUWLFXODUV VWDWHG RQ WKLV IRUP  LQFOXGLQJ LQFRPH UHFHLYHG IURP DOO VRXUFHV  DUH FRPSOHWH  WUXH DQG FRUUHFW
                                                                                    ΠLQ UHVSHFW RI H[SHQVHV FODLPHG RQ WKLV IRUP  DOO UHIXQGV UHFHLYHG WR GDWH IURP DQ\ VRXUFH DUH VKRZQ DQG , DJUHH WR
                                                                                     QRWLI\ WKH 5HYHQXH &RPPLVVLRQHUV RI DQ\ VXFK UHIXQGV UHFHLYHG LQ WKH IXWXUH
        claim for their travel expenses.                                           Signature ΠWR WKH EHVW RI P\ NQRZOHGJH QR SDUW RI WKHVH H[SHQVHV ZLOO EH YROXQWDULO\ UHLPEXUVHG WR PH
                                                                                               Date
                                                                                                 D D M  M Y  Y
                                                                                  RPC007013_EN_WB_L_2
                                                                                               Page 1  7HO  1R
         A. Hospital dialysis patients (where the patient attends hospital for treatment)Relief in
         respect of expenditure incurred travelling to and from hospital (unlimited journeys for all years)
         may be allowed at the following rates -                                           You make the
                                    Mileage/Kilometric Rates
                                                                                           claims on the
                      2012          2013          2014           2015
                                                                                           MED 1 FORM,
                  €0.27 per mile or   €0.27 per mile or   €0.27 per mile or   €0.27 per mile or
                   €0.17 per km  €0.17 per km   €0.17 per km  €0.17 per km                 page 2 at (J) –
                                                                                        OTHER QUALIFYING
         B. Home dialysis patients (where the patient uses a dialysis machine at home)
         Relief may be allowed in respect of expenditure up to the following amounts –       EXPENSES.
                                        Reliefs allowed
                               2012          2013          2014          2015
                                                                                               NOTE:
              Electricity      €1,935        €2,006       €2,100        €1,905           It is possible for a
                                                                                       patient to move from
          Laundry & protective
               clothing        €1,960        €1,935       €1,930        €1,925            one category of
                                                                                       treatment to another.
              Telephone        €305          €305          €305          €305
                                                                                        Where this happens,
                                                                                      relief for each category
                           €0.27 per mile or   €0.27 per mile or   €0.27 per mile or   €0.27 per mile or
              Travelling
                             €0.17 per km  €0.17 per km  €0.17 per km  €0.17 per km   may be apportioned as
                                                                                            appropriate.
         C. Chronic Ambulatory Peritoneal Dialysis (CAPD) patients (where the patient has treatment
           at home without the use of a dialysis machine)
         Relief may be allowed in respect of expenditure incurred up to the following amounts –
                                                                                     A tax refund cannot be more
                                        Reliefs allowed
                                                                                           than the tax you have
                               2012          2013          2014          2015
                                                                                         already paid in the given
              Electricity      €1,530        €1,585       €1,660        €1,505
                                                                                         year. You can claim for 4
                                                                                    years. For example: In January
              Telephone        €305          €305          €305          €305
                                                                                       2016 you can only make a
                           €0.27 per mile or   €0.27 per mile or   €0.27 per mile or   €0.27 per mile or
              Travelling                                                                claim going back to 2012.
                             €0.17 per km  €0.17 per km  €0.17 per km  €0.17 per km
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