{"text":"CHANGE OF DOCTOR \nPiease read the notes on the other side of this card. \n1. To be completed by the patienot \nI wish to join the list of \n{NAME OF DOCTO) v e e \n(DOCTOr's AdUress) .o, \n1f your own name or address is different from that on the \nfront of this card. please give your name or address here \nINEW NBITIC ..o censsitbitte e oot e ceasss e easr e e \nNew Address \nreemiesiisnnce POSECOAE \nYour Signature \nDIBEC e s cvsnn bbb e et e e ceeear e \n1f you are noc the patient, please state your refationship to \nthe patient \nGive this card to the doctor whose list you wish to join. \n2. To be completed by the new doctor \n[ accept this patient on my list \nDOCIOE'S SIBNATUIE ...oouriorrersrrvmresonnsrsmmsssssss mssssassssases consssssss e \nIDADL cornveseaitsnsstrrverrsresserssarsosssessoss 1000 1o astt saasosseBsoLt st K tbrssebrs sraserrese tosmense \nIf you will be dispensing drugs for this patient, please enter \nD here \n[ ] \nIf you are claiming a rural practice fund (mileage) payment \nNATIONAL HEALTH SERVICE MEDICAL CARD \nplease give the number of miles between your main surgery \nand the patient\u2019s home. \nL] \nIndex No. \nCommunity Health \nSerial No. \nDate of Birth \n21705784 \n2T 0% \nN.H.S. No. \n31073844100 \nISSUED BY THE \nPRACTITIONER SERVICES DIVISION \nClifton House, Clifton Place \nName \nTARYA DARLIHNG \nAddress \nGOOD SHEPHERD CENTRE \nGREERNGCK \nDISHOPTON \nPAT . 5PF \nRD \n27\/01740 \nAcceptance Date \nForm G.P4 (COMP) \nIMPORTANT. PLEASE READ THE INFORMATION ON PAGES 2 AND 3 AND KEEP THIS CARD 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