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Regulations 9(1), 10(1) and 11(1)
1. Medical qualifications, where obtained and evidence that the applicant is suitably qualified within the meaning of the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1979(1).
2. Declaration that he is a registered medical practitioner, included in the Medical Register in that name.
3. Registration number in the Medical Register and date of first registration.
4. Present or most recent appointment and, if in general practice, whether as a principal, assistant or locum.
5. Particulars of any outstanding application for inclusion in the medical list.
6. Whether or not applied/intending to apply for inclusion in—
(a)the obstetric list;
(b)the minor surgery list; or
(c)the child health surveillance list.
7. Information about general medical services to be provided and, in particular, whether they will—
(a)include exclude be limited to | }maternity medical services |
(b)include exclude be limited to | }contraceptive services— |
(i)excluding including | }the fitting of intra-uterine devices |
(ii)restricted not restricted | }to patients to whom the doctor or partner provides other personal medical services |
(c)include exclude be limited to | }child health surveillance services |
(d)include exclude be limited to | }minor surgery services |
8. Undertaking to be bound by the terms of service.
S.R. 1979 No. 460, as amended by S.R. 1986 Nos. 69 and 309 and S.R. 1994 No. 499
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