Provider Portal - Forms - Pick n Pay - Primary option

Select a scheme and option

View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.

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Patient forms
Integrated care programme	Application form
Primary option chronic medication	Application form
Palliative care	Application form
Maternity programme	Enrolment form
HIV YourLife programme	Application form
Chronic medication advance supply form	Chronic medication advance supply application form
Mental health programme	Enrolment form
Dental consent form	Dental consent form
Psychiatric - outpatient mental health benefits	Psychiatric application form - outpatient mental health benefits
Psychiatric application form - motivation for psychiatric admission	Psychiatric application form - motivation for psychiatric admission
Psychiatric in-hospital event - first progress report	Psychiatric in-hospital event - first progress report
Psychiatric in-hospital event - second progress report	Psychiatric in-hospital event - second progress report
Radiology request	Radiology request form
Pathology request	Pathology request form
Acute dialysis request and update	Application form
Chronic renal dialysis	Application form

Resources for you and your patient

Momentum Carecross GP Guide

Health4Me network GP patient education pad

English, Afrikaans, Sesotho, isiZulu

Health4Me network GP IVR flow diagram