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Transfer of Medical Notes Request
Newlands Medical Centre
June 2012
Transfer of Medical Notes Request
NEWLANDS MEDICAL CENTRE
15 Batchelor Street
PO Box 26-062, Newlands
Wellington
Ph: (04) 478-9858 Fax: (04) 478-9852
For GP2GP:
NZMC: 8929 HPI: 19ACNP
Dr James Aubrey
EDI: nulandmc
To Dr (Previous Doctor): ………………………………………................... Date:…..../………/……..
Medical Centre: ………………………………………………………………………
Address: …………………………………………………………………………………………………………………………
Phone: (……..) …………………………. Fax: (……..) …………………………….
PLEASE NOTE – Each person aged 16 years and over MUST SIGN their own
Transfer of Medical Notes Request.
The following patient(s) have joined our medical centre:
Family Name First Name D.o.B Gender
Male/Female
NHI
Could the medical notes of the above named people please be forwarded to Newlands Medical Centre
by GP2GP, via EDI, or by post.
Signed:
Date: Witness:
(NMC use only please
)