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Registration Reference Manual
Example: FP69 – Lost Trace
Form type: green pre-printed double-sided card.
Surname
ADDRESS
....................... HEALTH AUTHORITY
A communication recently sent by the Authority to the above named has:
(a) been returned through the Dead Letter Office.
(b) been returned indicating that the person has moved to an
(c) not elicited any response whatever despite a reminder.
The HA therefore wish to give notice that in accordance
with Regulation 20(3) of the National health Service (General
Medical and Pharmaceutical Services) Regulation 1974, this
patient's name will be removed from your list at the end of six
months unless meanwhile you can satisfy the Committee that you are
responsible for providing general medical services for him/her. Should this
person apply for treatment after his/her name has been removed it will be
necessary for a fresh acceptance to be sent to the HA.
N.B.:
1.
2.
3.
Dr................................................................................................
N.H.S. No.
Date of Birth
NATIONAL HEALTH SERVICE
outside the HAs area.
If you know this patient's present address, please enter it
overleaf and return this card to the HA.
If you are unable to give a later address you may like to keep this
card with the patient's medical record envelope as a reminder.
Please keep the medical record envelope until application is
made for it.
Action under regulation 20(3) is without prejudice to any earlier
removal of the name from your list under any other provision of
the regulations eg(notification of death, etc).
...........................................................
Chief Executive, Health Authority.
Date.......................................
Version: 2.13
Example Forms/Labels
Forenames
M Y
address
Form FP69
Appendix C C-5
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