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Registration Reference Manual
Example: FP4 – NHS Medical Card
Form type: white and purple pre-printed card.
This is your
NHS medical card
Please keep it in a safe place. it is proof
that you are entitled to NHS treatment.
Your NHS number is
Please tell us this number if you get in touch with
us. It will help us to find your records more quickly.
Your doctor is
What to do if you want to change your doctor
To the patient
1 Please read the notes about this on the
other side of this card
2 Fill in this part of the card and give it to the
new doctor to sign it
Your signature
Date
/
If you are not the patient, please say what If you will be dispensing drugs, tick here
your relationship is to the patient
Name and address if either is different from above
Postcode
/
Version: 2.13
Example Forms/Labels
Your local Family Health Services Authority (HA) is
Your date of birth
To the new doctor
Please fill in this part of the card
Your name
Your code number
Your signature to accept this patient
Date
/
/
If you claim a rural practice payment,
number of miles between your
main surgery and the patient's home
Office use
FPC cipher
Appendix C C-7
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