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

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

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

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

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.