Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for St. Pancras, London, Borough of]
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78
ST. PANCRAS BOROUGH COUNCIL.
Public Health Department.
The Voluntary Notification of Pulmonary Phthisis.
Certificate of Medical Practitioner.
I hereby Certify that in my opinion:— | |
Name in full of the Patient | |
Age of Patient | |
Sex | |
Full Postal Address of House of which Patient is an Inmate | |
If the Patient is an Inmate of a Hospital— | |
(4) Date at which Patient was so brought | |
Infectious Disease from which the Patient is suffering | |
"Whether the case has occurred— | |
Dated the day of 190 . | |
(Signed) , Medical Practitioner. | |
Address of person signing |