xmlns:atom="http://www.w3.org/2005/Atom" xmlns:atom="http://www.w3.org/2005/Atom"

Signed by authority of the Secretary of State for Health and Social Care

Name

Minister of State

Department of Health and Social Care

Address

Date

Sealed with the Official Seal of the Department of Health in Northern Ireland [date]

Name

A senior officer of the Department of Health in Northern Ireland