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Click ‘Get Form’ to open it in the editor.
Begin with Part A: About You. Fill in your title, surname, first name(s), date of birth, driver number, address, telephone numbers (home and mobile), postcode, and email using BLOCK CAPITAL letters.
Move to Part B: About Your GP and Your Consultant. Enter your GP’s name and address, consultant's name and address, their telephone numbers, and the dates you were last seen by them.
In Part C, provide details of any other clinics you are attending. Include the clinic name, reason for attendance, date seen, and any relevant reference numbers.
Proceed to the medical history section. Indicate any cardiovascular problems by ticking the relevant boxes and providing dates of diagnosis or treatment.
Complete the medication section by listing current medications along with dosages and reasons for taking them.
Review all sections carefully before signing the consent declaration at the end of the form.
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The Bulletin, School of Nursing Alumni Association, 1978
by M Summers The Alumni Bulletin will be sent automatically to all association members; individuals who are not association members may obtain a copy of TheRead more
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