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Temporary services GMS3/99 Please complete in BLOCK CAPITALS and tick Patient s details s Mr s Mrs s Miss s Ms s as appropriate Date if claim sent electronically Surname Date of birth First names NHS No. Previous surname/s Home address Temporary address if applicable Postcode Telephone number Details of treatment should be sent to Doctor s name and full address To be completed by the doctor Emergency treatment s Immediately necessary treatment s Minor surgical operation Temporary resident s...
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