{"text":"1. \n4 \nCHANGE OF DOCTOR \nPlease read the notes on the other side of this card. \nTo be completed by the \nI'wish to join the list of \n(Name of Doctor)..., \n{Dactor's Address) .. \npatient \nIf your own name or address is different from that on the \nfront of this card, please g; \nNew Name......, \nNew Address . \nYour Signature........ \nI you are not the patient, \nthe patient \nGive this card to the doct \nTo be completed by the \nive your name or address here \nplease state your relationship to \nor whose list you wish to join. \nnew doctor \nTaccept this patient on my list \nDoctor's Signature ... \nRef. NO-...eesase e \nIf yon will be dispensing drugs for this patient, please enter \nD here \n[ ] \nIf you are claiming a rural \nplease give the number of \nand the patient's home. \npractice fund (mileage) payment \nmilcs between your main surgery \nL] \n\u2014_\u2014\u2014\u2014\u2014 \u2014 \u2014 \u2014\u2014 v \u2014\u2014 . \nW \nC} f'\\m \nc o 3 S \nZ 2 ~ 8% \no~ \u2122 e \n5 3 N 3 \\1:5 \n= ~ & \n2 s 2| o~ =\u00ab \nwZ qzn N g!\u2019. \nEom - \n53 T WD~ <5 \ng8 2 N |7y = \ng 5 W [>e) o = \nQ o o ~ S g \n= 8 = \"] 3 a \ni \u2122 = S 5 \no & o \nv \n2 <8 \n$ =z Z \na \u00a2 & \n\u00a3 @A v = \n= 58 2 \nH AR a \nU Lang z \nS Eis 2 \nRE >-;s & \n= QM' iad l.: \n\u00a9 afgE o \n[oss e \nn-l\": a\ufb01om = \ni \u00a2 : \nEE oo - \no] e \n= \u00a7G - L E \nj o \nR A 2 \nz ey \nQo AL b e o \ne v O oaa, = \nS A 2 \n< o \nZ EA-RRrEN 5 \nAL T3 0 e W . \n- 13w A g \n- \n2 [ \nv e \nB 9 . \u00a7 \nz 2 5 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