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In Woolwich, the Council contributed £400 in 1913. The Local Committee
invited the Borough Council to take the dispensary over, but the Central Fund
refused to assist them in paying their debt if this course was taken. Apparently,
it will be necessary for a time to go on under the Central Fund.
APPENDIX B.
Form of inquiries of particulars required under the Regulations.
Public Health (Tuberculosis) Regulations, 1911. Record No.
Form No. 4.
TUBERCULOSIS
Medical Record of case of Pulmonary Tuberculosis notified to the Medical Officer
of Health under the Public Health (Tuberculosis) Regulations, 1912.
Serial No. in Notification Register
Date of Receipt of Notification 19
1. Particulars of Patient.
Name Age Sex
Whether Poor Law (P), Hospital (H), Medical Practitioners' (M), or School (S) case
Address;
(i) If in a Poor Law Institution, Hospital, Private Residence or otherwise. Address of
Patient
Any other Address to be visited
(ii) Changes of Address, where to
If to another Medical Officer of Health's District, name thereof, and date when
particulars sent to that M.O.H.
Including particulars of Medical History
2. Personal and Family History.
Number in family, adults, lodgers, children :
Ages:
Previous History of Patient and Family History :
3. Diagnosis.
Symptoms:
Verification of the Notification : Method
Bateriological Examination of sputum or other method of diagnosis : Dates
Results
Probable predisposing causes of infectivity :
Probable sources of infection,
Nutrition: Occupation:
Other particulars of diagnosis and personal particulars: