NHS FP17DC Form

Printing the FP17DC Form in Ascend

To print your FP17DC form with pre-populated NHS and/or Private Treatment charges, complete the following:

Go to the Chart tab and document procedures for a patient

Go to the TX Planner tab. You will see the procedures that have been documented on the Chart. Create a new case and assign the relevant procedures to the case. 

Go to the NHS Claims tab, and click the Create Claim button on the righthand side

This will bring up a new NHS Claim form. Select the related NHS Patient Charge associated with the procedures that are to be carried out. Click save

Go back into the TX Planner. There will be an NHS Patient Charge added to an unassigned case. Drag and drop this to the case you made earlier.

You are now ready to generate the FP17DC Form

Click the FP17DC Estimate button

This button launches the printable PDF version of the form with the following details pre-populated:

• Contractor’s Name
• Practice's Address
• Practice's Telephone
• Patient Name
• Date of Acceptance
• NHS Treatment Codes
• Private Treatment Codes
• NHS Information
• Patient Declaration
• NHS charges
• Total Private Charges
• Patient Signature area

Once the form has been printed, you will need to manually fill in the revision number (the number of times the form has been amended/treatment plan has changed).

The form can then be given to the patient to sign and confirm the treatment plan.