2738
No. 12 of 1923.
VACCINATION.
FORM NO. 3.
[ss. 9, 11 and 12 (3).]
(a) Not to exceed two months from the date of the certificate.
Hongkong.
Certificate of successful vaccination other than for a child.
I, the undersigned, hereby certify that I have personally vaccinated (fill in name and sex of person vaccinated) of
and that I have this day satisfied myself by personal inspection that the operation was successful.
Dated the
day of
(Signed.)
19?
Superintendent, Deputy Superintendent, Registered
Medical Practitioner or Public Vaccinator.
N.B.—No fee is payable to any public vaccinator for this vaccination or the granting of this certificate.
Hongkong.
FORM No. 4.
[ss. 14 (6) and 22.]
Certificate of successful vaccination of child.
I, the undersigned, hereby certify that I have personally vaccinated (fill in name, if any, date of birth, sex and parentage of child) of and that I have this day satisfied myself by personal inspection that the operation was successful.
Dated the
day of
(Signed.)
19
Superintendent, Deputy Superintendent, Registered
Medical Practitioner or Public Vaccinator.
N.B.—No fee is payable for this certificate. This certificate must, within seven days after the date thereof, be produced by the guardian of the child to the Head of the Sanitary Department.
FORM NO. 5.
[ss. 14 (7) and 23.]
Hongkong.
Certificate of unfitness for successful vaccination of child.
I, the undersigned, hereby certify that I am of opinion that (fill in name, if any, date of birth, sex and parentage of child) of
is not now in a fit and proper state to be successfully
vaccinated for the following reasons, viz. :
recommended the postponement of the vaccination until the
day of (a)
Dated the
day of
19
(Signed.)
Superintendent, Deputy Superintendent, or Registered Medical Practitioner.
N.B.—(1) After the expiration of the above period this certificate may be renewed by the Superintendent or by a Deputy Superintendent or by a medical practitioner.
(2) This certificate must, within seven days after the date thereof, and within seven days after the date of every renewal thereof, be produced by the guardian of the child to the Head of the Sanitary Department for registration.
2738
No. 12 of 1923.
VACCINATION.
FORM NO. 3.
[ss. 9, 11 and 12 (3).]
(a) Not to exceed two months from the date of the certificate.
Hongkong.
Certificate of successful vaccination other than for a child.
I, the undersigned, hereby certify that I have personally vaccinated (fill in name and sex of person vaccinated) of
and that I have this day satisfied myself by personal inspection that the operation was successful.
Dated the
day of
(Signed.)
19
?
Superintendent, Deputy Superintendent, Registered
Medical Practitioner or Public Vaccinator.
N.B.-No fee is payable to any public vaccinator for this vaccination or the granting of this certificate.
Hongkong.
FORM No. 4.
[ss. 14 (6) and 22.]
Certificate of successful vaccination of child.
I, the undersigned, hereby certify that I have personally vaccinated ( fill in name, if any, date of birth, sex and parentage of child) of and that I have this day satisfied myself by personal inspection that the operation was successful.
"
Dated the
day of
(Signed.)
19
Superintendent, Deputy Superintendent, Registered
Medical Practitioner or Public Vaccinator.
N.B.---No fee is payable for this certificate. This certificate must, within seven days after the date thereof, be produced by the guardian of the child to the Head of the Sanitary Department.
FORM NO. 5.
[ss. 14 (7) and 23.]
Hongkong.
Certificate of unfitness for successful vaccination of child.
I, the undersigned, hereby certify that I am of opinion that (fill in name, if any, date of birth, sex and parentage of child) of
is not now in a fit and proper state to be successfully and that I have vaccinated for the following reasons, viz. : recommended the postponement of the vaccination until the
day
of (a)
Dated the
19
day of
19
(Signed.)
Superintendent, Deputy Superintendent, or Registered Medical Practitioner.
N.B.--(1) After the expiration of the above period this certificate may be renewed by the Superintendent or by à Deputy Superintendent or by a medical practitioner.
(2) This certificate must, within seven days after the date thereof, and within seven days after the date of every renewal thereof, be produced by the guardian of the child to the Head of the Sanitary Department for registration.
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