711797-1867-HONGKONG-ANNO-TRICESIMO-PRIMO-VICTORIE-REGINE-SIR-RICHARD-GRAVES-MACDONNELL-Knight-C-B--Governor-and-Commander-in-Chief-NO-10-OF-1867- — Page 12

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I, A.B. of

THE HONGKONG GOVERNMENT GAZETTE, 27TH JULY, 1867.

(F.)

(Voluntary Submission to Examination.)

"THE CONTAGIOUS DISEASES ORDINANCE, 1867.”

+

in pursuance of the above mentioned Ordinance, by this Submission, voluntarily subject myself to a periodical Medical Examination by a Visiting Surgeon for Months from the Date hereof.

279

Dated this

Witness, X.Y.,

Registrar General.

Day of

(G.)

18

(Signed,)

A.B.

(Notice by Visiting Surgeon to Woman of Times, &c., of Examination.)

"THE CONTAGIOUS DISEASES ORDINANCE, 1867.”

To A.B. of

Take Notice, that in pursuance of the above mentioned Ordinance, you are required to attend for Medical Examination as follows:

[Here state Times and Places of Examination.]

Dated this

Day of

18.

(Signed,)

E.F., Visiting Surgeon.

(H.)

(Certificate of Visiting Surgeon.)

"THE CONTAGIOUS DISEASES ORDINANCE, 1867.”

In pursuance of the above mentioned Ordinance, I hereby certify that I have this Day examined A.B. of

and that she is affected with a Contagious Disease within the Meaning of that Ordinance; and the Hospital in which she is to be placed under the said Ordinance is the

7

Dated this

Day of

(J.)

18

(Signed,)

E.F.,

Visiting Surgeon.

(Order by Inspector of Hospitals for Transfer.)

"THE CONTAGIOUS DISEASES ORDINANCE, 1867."

By virtue of the Power in this Behalf vested in me by the above mentioned Ordinance, I hereby order that A.B. of

now detained under that Ordinance in the Hospital of

for Medical Treatment, be transferred thence to the Hospital of

Dated this

Day of

(K.)

18

(Signed,)

M.N.,

Inspector of Hospitals.

(Certificate for Detention beyond Three Months,)

"THE CONTAGIOUS DISEASES ORDINANCE, 1867.".

I, the undersigned, hereby certify that the further Detention for Medical Treatment of A.B. of

now an Inmate of this Hospital, is requisite.

Dated this

Day of

18

at the

Hospital.

(Signed,)

M.N.,

Visiting Surgeon.

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