GP Name definition

GP Name. Signature: Date: Once signed please detach this sheet and Email to the number shown above. BACK-UP ADVICE AND SUPPORT
Sample 1Sample 2Sample 3
GP Name. Signature: Date: Once signed please email or fax back to the team. CONSENT SECTION TO BE COMPLETED BY PATIENT / REPRESENTATIVE I agree*/don’t agree* to enter into a shared care arrangement for the above treatment (*delete as appropriate) Patient / Representative Name: Signature: Date: BACK UP ADVICE AND SUPPORT Contact details Telephone number Sandwell Base 0000 000 0000 Contact details Telephone number Wolverhampton Base 01902 444 021 Version Control Version Date of Approval Author/s Brief Description of Changes
Sample 1Sample 2
GP Name. Signature: Date: Once signed please email or fax back to the team. CONSENT SECTION TO BE COMPLETED BY PATIENT / REPRESENTATIVE I agree*/don’t agree* to enter into a shared care arrangement for the above treatment (*delete as appropriate) Parent / Representative Name: ________________________Signature:__________________ Date:_____________________ BACK UP ADVICE AND SUPPORT Contact details Telephone Sandwell Base 0000 000 0000 Contact details Telephone Wolverhampton Base 01902 444 021 01902 444 021 Version Control Version Date of Approval Author/s Brief Description of Changes
Sample 1

Examples of GP Name in a sentence

  • An agent will guide you and register your DSP*, or send a WhatsApp to 0861 84 32 36 with your member number.(Please provide the DSP GP Name and Practice number that must be linked to the family dependants (Name and date of birth).

  • CertificationI certify that I have examined this report and that to the best of my knowledge and belief, all statements in this report are true, correct and complete.Official Title: SVP ASSOC GEN COUN GOV AND REG AFFExact Legal Title or Name of Respondent: WXTV LICENSE PARTNERSHIP, G.P. Name: CHRISTOPHER G.

  • An agent will guide you and register your DSP*, or send a WhatsApp to 0861 84 32 36 with your member number.(Please provide the DSP GP Name and Practice number that must be linked to the family dependants (Name and date of birth).Log onto www.thebemed.co.zaand follow the “Providers” then the “Designated Provider” link to select a DSP*.

  • Name of Medical Aid: Plan: Membership Number: Name of Main Member: GP Name: Tel No: E.

  • DATE> <GP Address> Dear <GP Name> [Patient name] is currently on our waiting list for [insert procedure].

  • Please note that the panel requires all information submitted to be anonymised, the maximum identifiers should be: NHS Number and General Practitioner (GP) Name & Practice; to protect patient confidentiality and ensure panel objectivity.

  • Ensure that this column is left blank during SHG level data collection.2.1 Animal husbandry - Group Name of the SHG: Name of the VO:Name of the GP: Name of the SHG: Name of the VO:Name of the GP: Name of the SHG: Name of the VO:Name of the GP: Facilitator’s Note for Animal Husbandry - Group For SHG members who wish to start animal husbandry collectively as a group.

  • PATIENT PERSONAL DETAILS Patient Name: Date of Birth: NHS Number: GP Name & Practice Details: Please note that all personal information will be removed prior to the consideration by the Individual Funding Request process.

  • Group is an indicator variable equal to 1 if the insurer is affiliated with a group.

  • Details of GP Name: .............................................................................................................................................


More Definitions of GP Name

GP Name. Signature: Date: ESCA for ADHD- Methylphenidate Page 1 of 8 Version 1.0 December 2018 Once signed please email or fax back to the team. CONSENT SECTION TO BE COMPLETED BY PATIENT / REPRESENTATIVE I agree*/don’t agree* to enter into a shared care arrangement for the above treatment (*delete as appropriate) Parent / Representative Name: Signature: Date: BACK UP ADVICE AND SUPPORT Contact details Telephone Sandwell Base 0000 000 0000 Contact details Telephone Wolverhampton Base 01902 444 021 Version Control Version Date of Approval Author/s Brief Description of Changes
Sample 1
GP Name. Address: Telephone Number: Signature: Fax Number: Date: Email: Written by (clinician): Version 2 Written by (pharmacist): Xxxxxx Xxxxxxx 10 May 13 Date of issue: Approved by North Staffordshire Area Prescribing Committee (date): Review Date: Version number:2 Effective Shared Care Agreement for the treatment of: Mania, bipolar disorder and depression with lithium This shared care agreement outlines the ways in which the responsibilities for managing the prescribing of lithium will be shared between the specialist and general practitioner (GP). If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition will remain with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practical. Sharing of care assumes communication between the specialist, GP and patient. The intention to share care should be explained to the patient by the doctor initiating treatment. It is important that patients are consulted about treatment and are in agreement with it. The doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use.
Sample 1

Related to GP Name

  • s Name Property Address: _________________________________________________________

  • Common name means any designation or identification such as code name, code number, trade name, brand name or generic name used to identify a chemical other than by its chemical name.

  • Print Name Signature: Date:

  • Contact Name Date: Address: Phone: City: State: Zip Code: Email: Credit card Check

  • Company Name Address: Attention: Tel: Fax: Email: If sent to Cornell: For all correspondence except payments Center for Technology Licensing at Cornell University Attention: Executive Director 000 Xxxx Xxxx Xxxx, Xxxxx 000 Xxxxxx, XX 00000 FAX: 000-000-0000 TEL: 000-000-0000 EMAIL: xxx-xxxxxxxxx@xxxxxxx.xxx For all payments – If sent by mail: Center for Technology Licensing at Cornell University XX Xxx 0000 Xxxxxx, XX 00000-0000 If remitted by electronic payments via ACH or Fed Wire: Receiving bank name: Xxxxxxxx Trust Co. Bank account no.: 0111000065 Bank routing (ABA) no.: 000000000 SWIFT code: Bank account name: XXXXXX00 Cornell University Bank ACH format code: Not required Bank address: X.X. 000, Xxxxxx, XX 00000 Additional information: Reference D-4677 Agreement No.: <to be assigned> An email copy of the transaction receipt shall be sent to xxx-xxxxxxxxx@xxxxxxx.xxx. Licensee is responsible for all bank charges of wire transfer of funds for payments. The bank charges shall not be deducted from the total amount due to Cornell.

  • Legal Name means the name of the company, corporation or other entity constituted as a legal person under which this person exercises its rights and performs its obligations.

  • Chemical name means the scientific designation of a chemical in accordance with the nomenclature system developed by the International Union of Pure and Applied Chemistry (IUPAC) or the Chemical Abstracts Service (CAS) rules of nomenclature, or a name which will clearly identify the chemical for the purpose of conducting a hazard evaluation.

  • Product name means the name of the commercial feed which identifies it as to kind, class, or specific use.

  • Trade name means the name of the Hotel set forth in the Addendum.

  • Generic name means a short title which is descriptive of the premium and benefit patterns of a policy or a rider.

  • Authorized Signatory means the designated person of the agency authorized to represent the agency in all matters pertaining to its Proposal. The designated person should hold the Power of Attorney duly authorizing him/ her to perform all tasks including but not limited to sign and submit the Proposal to participate in all stages of the RFP Process, to conduct correspondence for and on behalf of the agency, and to execute any document required to give effect to the outcome of the RFP Process;

  • Service address means the service address of a member or the body corporate in terms of rule 4; and

  • Limited Liability Company Agreement means the Amended and Restated Limited Liability Company Agreement of the Depositor, dated as of March 1, 2001, executed by Ford Credit, as sole member; or the Limited Liability Company Agreement of Ford Credit, dated as of April 30, 2007 and effective on May 1, 2007, as the context requires.

  • IP Address means a unique number on the Internet of a network card or controller that identifies a device and is visible by all other devices on the Internet.