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Change of GP work
Title
First name
Last name
Membership number
Email address
Telephone number
Type of work
Work start date
Work end date
Is the work NHS or private?
NHS
Private
Work address and postcode
Total number of sessions worked during the current membership year
Do you want the MDU to indemnify this work?
Yes
No, I have NHS indemnity
No, I have other indemnity
If you require MDU indemnity, is this work carried out under an NHS England contract?
Yes
No
Type of work
Work start date
Work end date
Is the work NHS or private?
NHS
Private
Work address and postcode
Total number of sessions worked during the current membership year
Do you want the MDU to indemnify this work?
Yes
No, I have NHS indemnity
No, I have other indemnity
If you require MDU indemnity, is this work carried out under an NHS England contract?
Yes
No
Type of work
Work start date
Work end date
Is the work NHS or private?
NHS
Private
Work address and postcode
Total number of sessions worked during the current membership year
Do you want the MDU to indemnify this work?
Yes
No, I have NHS indemnity
No, I have other indemnity
If you require MDU indemnity, is this work carried out under an NHS England contract?
Yes
No
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