{"text":"4 \nCHANGE OF DOCTOR \nPlease read the notes on the other side of this card. \nTo be completed by the patient \nT wish 1o join the list of \n(Name of Doctor) ..., \n(Doctor\u2019s Address).................. \n[f your own name or address is different from that on the \nfronc of this card, please give your name or address here \nNew Name. ..o, \nNew Address .. \nYour $igrature. ... \nIf you are not the patien, please state your relationship to \nthe paticat \nGive this card to the doctor whose list you wish to join. \n2. \nTo be completed by the new doctor \nTaccept this patient on my lisc \nDoctor's Signature ... saasattebassanesi benne \nDIAUE e eeeeeesecess oo \nIf you will be dispensing drugs for this patient, please cnter \nD here \n(] \nIf you are claiming a rural practice fund (mileage) payment \n| \n| \nl \ni \n| \nplease give the number of miles between your main surgery \nand the patient\u2019s home. \n[ ] \nNATIONAL HEALTH SERVICE MEDICAL CARD \n2] ] S \nc - \nZ @ ~ \nE O~ - \n= S =3 \nF N \n= T e D - \nTE z @ o \n& s XA \nI< t WIS \n8% 2 W=z 2 o \n= et \u2122 0 b=1 \n9 : o <] 2 \nN Lo v \ng = - \u00a7 \n~Nom = \ng \nz \n7z \no \n\u00a2 \nB S \no \no \nwBE% \nQ& \nS23s \n\u201cEE X \ngegs b \nZES = \nsz TS Ll \n\"ng W \ng 1 a \n> oo \n\u00a7 et LU \n- T ot \nB woa, . om \no LIM O - \nT e e \nMoo e \nB - O N \n3-@\u201c4:: \nTN \n\u20ac O o wd ol \ne 33 M A \ng \nZz - a8 \nForm G.P.4 (COMF) \nIMPORTANT. PLEASE READ THE INFORMATION ON PAGES 2 AND 3 AND KEEP THIS CARD 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