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Registration Reference Manual
Example: FP92 – Prescription Exemption Certificate
Form type: white pre-printed card
Family Health Services Authority Exemption Certificate
Improper use of this certificate may lead to prosecution. Please read notes overleaf
Family Health Services Authority of issue
NHS Number
Name
Address
NATIONAL HEALTH SERVICE – PRESCRIPTION CHARGES
This certificate is valid for the inclusive period from
This card is the property of the Family Health Service Authority
Version: 2.13
Example Forms/Labels
to
FP92 (COMP)
Appendix C C-3
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