Paragraph 24
If applicant is not in the FHSA’s medical list—
(1)
name of any other FHSA in whose list he is included;
(2)
particulars of any outstanding application for inclusion on the medical list of any FHSA;
(3)
information about general medical services to be provided and, in particular, whether—
| (a) including excluding | maternity medical services limited to |
| (b) including excluding limited to | contraceptive services |
| (i) excluding including | fitting of intra-uterine including devices |
| (ii) restricted not restricted | to patients to whom the doctor or partner provides other personal medical services |
| (c) including excluding limited to | child health surveillance services |
| (d) including excluding limited to | minor surgery services |
(4)
whether or not applied/intending to apply for—
(a)
inclusion in minor surgery list,
(b)
inclusion in child health surveillance list,
(c)
inclusion in obstetric list; and
(5)
undertaking to be bound by terms of service.