NPL 3: National performers lists change notification form: Change in registered address, practice within existing area team or status of inclusion Notes for completion A performer is required to notify NHS England of any change requiring amendment to the information recorded in a performer list as set out Regulation 19 (1) in the National Health Service (Performers Lists) (England) Regulations 2013. The notification must be given within 28 days of the change unless it is impractical for the performer to do so. Changes include any change of registered address, practice or the status of inclusion in the list. State reason for submitting this change notification form. Medical performers should complete section 1 only Dental performers should complete section 2 only Ophthalmic performers should complete section 3 only Medical and dental performers providing services for the first time following completion of traineeship should also provide their certificate of completion of training/vocational training certificate together with a letter of clinical reference from their trainer. Forms should be sent to the area team in which the performer will be working. Contact details can be found at: Section 1 National medical performers list 1. Please provide the following general information. Name: GMC number:
NPL 3: National performers lists change notification form: Change in registered address, practice within existing area team or status of inclusion Notes for completion A performer is required to notify NHS England of any change requiring amendment to the information recorded in a performer list as set out Regulation 19 (1) in the National Health Service (Performers Lists) (England) Regulations 2013. The notification must be given within 28 days of the change unless it is impractical for the performer to do so. Changes include any change of registered address, practice or the status of inclusion in the list. State reason for submitting this change notification form. Medical performers should complete section 1 only Dental performers should complete section 2 only Ophthalmic performers should complete section 3 only Medical and dental performers providing services for the first time following completion of traineeship should also provide their certificate of completion of training/vocational training certificate together with a letter of clinical reference from their trainer. Forms should be sent to the area team in which the performer will be working. Contact details can be found at: Section 1 National medical performers list 1. Please provide the following general information. Name: GMC number:
npl3-change-notific.docx