Form AA1, Claim for Attendance Allowance Completed Form Examples and Samples
View practical examples of how to fill out Form AA1, Claim for Attendance Allowance. Our annotated samples help you understand how to accurately report medical conditions, care needs, and personal details for your application.
Filling Out Form AA1, Claim for Attendance Allowance: A Practical Example
How this form was filled:
This example demonstrates how an AI can accurately extract relevant health and personal details from an unstructured patient care letter. By analyzing the narrative, the system automatically populates the complex Form AA1 fields, ensuring accuracy and saving the claimant significant time.
Source document used: Medical Referral/Support Letter
Dear Department for Work and Pensions, I am writing to support the Attendance Allowance claim for Arthur James Sterling, born on 14th July 1948. Mr. Sterling currently lives at 12 High Street, Oakwood, London, SE12 8AB. His National Insurance number is AB 12 34 56 C. He has not lived abroad for more than 4 weeks in the last 3 years and is not claiming under special rules. Arthur suffers from severe Osteoarthritis, Type 2 Diabetes, and Chronic Hypertension. He has been managing these conditions for over 8 years. For his mobility, he finds stairs very difficult and frequently stumbles, having had three falls in the last year, with the most recent one occurring on 10th January 2026. He is currently on a waiting list for a hip replacement, which was scheduled on 5th December 2025. His GP is Dr. Helen Richards at The Oakwood Medical Centre, located at 50 Station Road, London, SE12 9YZ, phone 020 7946 0123, whom he last saw on 20th January 2026. He also requires assistance from his daughter, Maria, who helps him with dressing and meal preparation twice daily. He confirms that he has not been in a hospital or care home in the last 6 weeks. I have attached his recent medical assessment report to this letter for your review.
Information used to fill out the document:
- Personal Details: Arthur James Sterling, DOB: 14/07/1948, NI: AB 12 34 56 C
- Current Address: 12 High Street, Oakwood, London, SE12 8AB
- Medical Conditions: Osteoarthritis, Type 2 Diabetes, Chronic Hypertension
- Mobility & Falls: Three falls in the past year, last fall 10/01/2026
- GP Information: Dr. Helen Richards, Oakwood Medical Centre, 020 7946 0123
- Surgery Status: Waiting list for hip replacement (added 05/12/2025)
- Care Support: Assistance from daughter, Maria, for dressing and meals
What this filled form sample shows:
- Automatic extraction of PII (Names, NI number, Address)
- Conversion of narrative dates into form-compliant formats
- Identification of medical history and treatment status
- Mapping of unstructured assistance descriptions to relevant care sections
- Filtering of irrelevant document information for cleaner form output
Form specifications and details:
| Form Name: | Form AA1 |
| Purpose: | Claim for Attendance Allowance |
| Audience: | State Pension age residents with disabilities |
| Difficulty: | High - Requires detailed daily activity mapping |
| Focus: | Care needs, mobility, and medical supervision requirements |
| Categories: | VA claim forms |
| Created: | May 19, 2026 05:55 PM |