【申請須知】
(1) 申請人須符合以下資格：
(a) 按身份證明文件年滿18歲，並患有嚴重牙周病。
(b) 能夠提供以下文件：
• 有效住址證明 (三個月內)
• 申請人正領取綜援 (「綜合社會保障援助受助人 (醫療費用豁免證明書)」 或 「申請獲准通知書」) ；或
• 申請人為公屋居民 (「房署繳費通」電子繳費卡 或 與香港房屋委員會或香港房屋協會簽訂的租賃協議)；或
• 申請人收入不高於最新公屋每月入息限額 (如最近三個月內之糧單或最新課稅年度之稅單)
* 本計劃以綜援及公屋人士優先 *
(c) 健康狀況允許接受牙科治療，包括小型口腔手術。
(d) 過去六個月內沒有吸煙。
(e) 擁有至少十顆牙齒，並不需要全口假牙。
(f) 過去未曾接受過牙周治療、種牙或複雜口腔復康治療。
(2) 填寫申請表前，請先仔細閱讀「收集求診者個人資料聲明」(https://shorturl.at/fS1js) 。
(3) 請根據身份證明文件填寫相關個人資料及提供聯絡方法。
(4) 如有需要，本診所將聯絡申請人 (或其親友) 進一步提供文件。
(5) 由於申請人士眾多，閣下可能需要輪候一段頗長的時間。當輪候到閣下的申請時，我們會提早以電話或電郵通知閣下安排口腔評估。
(6) 請注意，若申請人未能在本申請表上提供正確的資料，或未能提供所需文件，其申請將不獲處理。此外，申請人需在口腔評估當日出示有效身份證或其他身份證明文件正本，確認身分及符合資格後方可接受檢查。
(7) 本診所的聯絡方法參見 www.iad.facdent.hku.hk 網頁。
(8) 如有任何爭議，香港大學牙醫專科診所 (IAD-MSC) 有權就「杜鵑牙周病治療計劃」的參加資格保留最終決定權。
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【Notes on Application】
(1) Applicants must meet the following criteria:
(a) Aged 18 years or above based on proof of identity, and suffering from severe periodontitis.
(b) Able to provide:
• Valid proof of address (dated within the last 3 months)
• Proof of the applicant receiving Comprehensive Social Security Assistance (“CSSA”) (“Certificate of Comprehensive Social Security Assistance Recipients (for Medical Waivers)" or "Notification of Successful Application") OR
• Proof of the applicant being a resident of Public Rental Housing (Housing Department e-Payment Card / a copy of the tenancy agreement from the Hong Kong Housing Authority or the Hong Kong Housing Society) OR
• Proof of the applicant's monthly income not exceeding the latest means-test threshold for public rental housing (payslip within the past 3 months or tax assessment of the most recent year of assessment)
* This project prioritises applicants who are receiving CSSA or are living in public rental housing. *
(c) Medically fit to receive dental treatments, including minor oral surgeries.
(d) No history of smoking in the past 6 months.
(e) Present with at least 10 teeth and do not require full arch dentures.
(f) No history of previous periodontal therapy, implant placements, or extensive crowns and bridgework.
(2) Please read through the "Statement of Collection of Personal Information from Patients" (https://shorturl.at/fS1js) before filling out this form.
(3) Please fill in the corresponding personal information on your identification document and provide your contact information.
(4) If necessary, IAD-MSC may contact the applicant (or their family members or friends) to request further documents.
(5) Due to the high volume of applicants, you may experience a considerable waiting period. Once your application has been processed, we will contact you in advance by telephone or email to arrange the screening oral examination.
(6) Please note that if the information provided on this application form is incomplete or inaccurate, or if you do not submit the required documents, the application will be deemed invalid and will not be processed. To receive our services on the day of the screening oral examination, applicants must present the original copy of their Hong Kong Identity Card or other proof of eligibility.
(7) To contact IAD-MSC, please visit www.iad.facdent.hku.hk.
(8) In case of any disputes, IAD-MSC reserves the right to make the final decision regarding eligibility for treatment under the Azalea Gum Treatment Project.
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