GP Name definition

GP Name. Signature: Date: Once signed please detach this sheet and Email to the number shown above.
Sample 1Sample 2Sample 3
GP Name. Signature: Date: Once signed please email or fax back to the team. 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 Contact details Telephone number Version Date of Approval Author/s Brief Description of Changes
Sample 1
GP Name. Signature: Date: CONSENT SECTION TO BE COMPLETED BY PATIENT / REPRESENTATIVE BACK UP ADVICE AND SUPPORT Sandwell Base 0000 000 0000 Wolverhampton Base 01902 444 021 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*.

  • 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.

  • 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 - Individual Animal husbandry will include livestock like poultry, pigs, goats, cows, etc.

  • 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 Group Farming: For SHG members who wish to undertake farming practices collectively as a group.

  • District Sub-division *Block Name / MunicipalCorporation / Municipality * GP Name /Ward No. Village Name *Flat/House No. / Building Landmark *Street / Lane Name *Pin Code *Post Office *Police Station No member of my family has ever held a Ration Card prior to this.

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

  • PATIENT PERSONAL DETAILSPatient Name: Date of Birth: NHS Number: Patient Address: GP Name GP Practice name: GP Postcode: 3.

  • G.P. Name Phone no Who is responsible for providing support in school Describe medical needs and give details of child’s symptoms, triggers, signs, treatments, facilities, equipment or devices, environmental issues etc.

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:

  • User Name means any user name allocated to the Customer for access to the Services;

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

  • Company Name Address: Attention: Tel: Fax: Email: 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 Center for Technology Licensing at Cornell University XX Xxx 0000 Xxxxxx, XX 00000-0000 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.

  • business name or "trade name" means the name of a licensed business as used by the licensee on signs and advertising.

  • Street Name means the form of registration in which the securities are held by a broker who is delivering the securities to another broker for the purposes of sale, it being an accepted custom in the United States securities industry that a security in Street Name is in proper form for delivery to a buyer and that a security may be re-registered by a buyer in the ordinary course.

  • By: Name Title: Date: ---------------------------------------------------

  • Project Name refers to the project title as stated in the legal agreement (Financing Agreement) between the World Bank and the Government. It should not be confused with the name of the UN Agency’s project or program financed from other sources.]

  • 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.

  • First Name XXXXX XXXX" and "XXXXX," or "XXXXXXX" and "XXXX."

  • Property Name Property Address: Control No.: The Mortgage File should be delivered to the following: ________________________________________ ________________________________________ ________________________________________

  • 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 such senior personnel of a Person as may be duly authorized and designated in writing by such Person to execute documents, agreements and instruments on behalf of such Person.

  • Bank Name Bank Address: Beneficiary: ABA No.: Account No.: Swift Code:

  • Logo means the SAP Partner logo as detailed in the SAP Partner Logo Usage Guidelines.

  • Name of Project means “Project No. Project Number and Description”

  • Street Address means, with respect to a physical location, the street name and number, city, state, and (if not the United States) country, and the postal code, if any, that is required for delivery of mail to the location. If, by reason of rural location or otherwise, a street name and number, city, or town does not exist, "street address" shall mean an appropriate description fixing as nearly as possible the actual physical location, but, for all locations in the United States, the county or parish and, if any, the rural free delivery route and the United States postal code shall be included.

  • Plain Old Telephone Service (POTS) means telephone service for the transmission of human speech.

  • Account Name means the name of the individual who lives with the child(ren) and who applies for the Children’s Health Insurance Program coverage on behalf of the child(ren).

  • 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.