View report page

117
FORM B.
Appendix G.
Corporation of London.
PUBLIC HEALTH DEPARTMENT.
PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912.
FORM OF NOTIFICATION by a School Medical Inspector
under Article VI. of Cases not previously notified by him.
To the Medical Officer of Health
for the City of London, Guildhall, E.C.
I hereby give you Notice that, in my opinion, the children of whom
particulars are appended are suffering from Tuberculosis.
Name of Child in full.
Age.
School.
Place of Residence.
(Give Home Address in full.)*
Localisation of
Disease.
Dated this—day of—19.
School Medical Inspector.
*Care should be taken to ascertain accurately the patient's place of residence. Where necessary the name of the
town or village, and of the county in which it is situated, should be stated, as well as the name or number
of the house and the name of the street.