How | To Fill Gp69 Form

Note: If you are referring to a different GP69 variant (e.g., from another country or organization), please clarify. The following is based on the common NHS England GP69: "Notification of permanent removal from a GP list."

Patient: Jane Doe, DOB 12/03/1985, NHS 123 456 7890 Address: 10 High Street, Town, POSTCODE Practice: Greenfield Surgery, ODS F12345 Removal date: 01/08/2025 Reason: Moved outside practice area (new address confirmed in next town) Last contact: 15/07/2025 via phone Declared & signed: Dr. A. Smith, 20/07/2025 how to fill gp69 form