H—3lB

Appendix.—General Practitioners Service: Suggested Form of Claim on Fund by a Medical Practitioner (Vide Para. 20)

To the Medical Officer of Health, I certify that the above particulars of general medical services afforded by me are true and correct, and I claim the sum shown at the foot of column (6) on behalf of the patients listed in column (3). Date : / / Signature of Practitioner.

Approximate Cost of Paper.—Preparation, not given ; printing (4,408 copies), £64.

By Authority: E. V. Paul, Government Printer, Wellington.—l94B.

Price 9d.]

18

[FOB DEPARTMENTAL USE] (1) (2) (3) (4) (5) (6) Date of Attendance. Code. Name of Patient (and if Child under Sixteen, Name of Parent or Guardian. Address. Total Pee Charged. Amount Claimed from Fund. Ledger Reference. £ s. d. £ s. d. (2) Code (to be printed on cover of pad of forms) M Morning, 7-12 noon T Telephone consultation A Afternoon, 12-9 p.m. E Extended more than 30 min. N Night, 9 p.m.-7 a.m. P Visit in private hospital S Sunday holidays or public R Reduced (short or trivial consultation) D Domiciliary B Materials l £