Clinical manual of mental diseases : for practitioners and students / by A. Campbell Clark.

  • Clark, Archibald Campbell.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual of mental diseases : for practitioners and students / by A. Campbell Clark. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    FORM OF STATEMENT. // any particulars in this Statement be not known, the fact to be so stated. Name of Patient, with Christian ) Name at length - - -\ Sex and Age When and where previously under ) Care and Treatment - - ( In any Asylum or Institution - Whether subject to Epilepsy - Whether Dangerous to others I certify that, to the best of my knowledge, the above particulars are correctly stated. Name _ Place of Abode [To be signed by the Parent or Guardian of the Idiot or Imbecile, or the Person undertaking and performing towards him the duty of the Parent or Guardian.] Here, it will be seen, there is no need for a judicial reception order, nor, in fact, any order beyond the medical certificate. FORM OF MEDICAL CERTIFICATES FOR SCOTLAND. MEDICAL CERTIFICATE, No. i. I, the undersigned, , do hereby certify that I have this day at , in the county of , personally examined , and believe to be of unsound mind, and to be capable of deriving benefit from training and treatment in the Institution for the Training of Imbecile Children at Name Medical Qiialificaiioti Place of Abode Datf.I) this day of One thousand eight hundred and