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119
FORM D.
ADDendix I.
Corporation of London.
PUBLIC HEALTH DEPARTMENT.
PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912.
FORM OF NOTIFICATION (after discharge) by Medical
Officers of Poor Law Institutions and Sanatoria under
Article VII. (b).
To the Medical Officer of Health.
for the City of London, Guildhall, E.G.
I hereby give you Notice that the persons affected with Tuberculosis, of
whom particulars are given below, have been discharged from*—
during the week ending—19—
Name in full.
Age.
Localisation of
Disease.
Place of Residence before
Admission.
(Give Address in full.)†
Place of Destination.
(Give Address in full.)†
Dated this—day of—19.
Medical Officer of the above-named Institution.
*Here state the name of the Institution.
†Care should be taken to ascertain accurately the patient's place of residence and place of destination. 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.