1923_ASYLUMS_ORDINANCE__1906 — Page 4

ASYLUMS.

No. 6 of 1906.

1673

SCHEDULE.

[s. 9.]

FORM A.

We,

certify that

Certificate of medical practitioners, under section 9.

and

, (medical practitioners) hereby at present detained for observation

under the authority of the Asylums Ordinance, 1906, is in our opinion a person of unsound mind.

The facts observed by me indicating that the said mind are as follows:-

is of unsound

(Here state facts.)

Dated the

day of

(Signed).

(Medical Practitioner.)

19

The facts observed by me indicating that the said mind are as follows:-

(Here state facts.)

is of unsound

(Signed)...

(Medical Practitioner.)

Dated the

day of

19

Countersigned.

Dated the

(Magistrate.)

day of

FORM B.

19

"

[s. 10.]

We,

Certificate of medical practitioners, under section 10.

and

2

(medical practitioners) hereby certify that it is in our opinion necessary to detain in an asylum for a further period of

days observation

now detained for observation under the authority of the Asylums Ordinance, 1906.

The reasons which in my opinion render it necessary to detain the said

for further observation are as follows :-

(Here state reasons.)

(Signed).

(Medical Practitioner.)