SCHEDULE (I.) MEDICAL JOURNAL and WEEKLY STATEMENT to be kept in each Licensed House for the Inspection of Commissioners or Visitors. Names of Names of No. of No. of No. of No. of probably Curable probably probably probably probably probably General Remarks No. of on the Women State of Health Curable Incurable Curable Incurable under under of the Patients, Men. Men. Women. Women. Restraint. Restraint. and Condition of the House. No. of In Cases of Restraint, the approbation or disapprobation of the Physician, Surgeon or Apothecary to be certified. (signed) Physician, Surgeon or Apothecary. To be inspected by the Commissioners or Visitors at their Visitation, and signed accordingly. SCHEDULE (K.) FORM of PERMISSION for regulating Medical Attendance. WHEREAS by an Act of Parliament made and passed in the Second year of the reign of His present Majesty, intituled, "An "Act for regulating the Care and Treatment of Insane Persons in England," it is amongst other things provided and Enacted, That when any House licensed for the reception of Insane Persons shall be licensed to receive less than Eleven Insane Persons, then it shall and may be lawful for a Majority of the said Commissioners, at any meeting under this Act, or the said Visitors, if they shall so think fit to direct and permit, that such House shall be visited by the Physician, Surgeon or Apothecary once at the least in every four weeks, instead of twice in every week, as required by the said Act: And whereas on the day of the Metropolitan Commissioners appointed under the said Act [or, the Justices] duly granted a License for the space of for a House situate at calendar months to of for the reception of Insane Persons: And whereas the said hath applied to the said Commissioners [or, Visitors] that they will be pleased to direct and permit the said House to be visited once in every four weeks instead of twice in every week: NOW KNOW YE, That we the undersigued Commissioners [or, Visitors] having thought fit to accede to the above request, do by this instrument in writing, under our hands and seals, direct and permit that the House so licensed to the said as aforesaid, shall be visited by a Physician, Surgeon or Apothecary once at the least in four weeks, instead of twice in every week, as required by the said Act: Provided always, and it is hereby expressly declared, That this permission shall be subject to such revocation or alteration as the said Metropolitan Commissioners [or, Visitors] shall think fit: Witness our hands and seals this Witness 18 SCHEDULE (L.) day of SCHEDULE (M.) FORM of BOOK of ENTRY of Patients to be kept in the Licensed Houses, and of Register to be kept by the Clerk of the Metropolitan Commissioners and Visitors, and of ANNUAL REPORT to be made by Public Hospitals and Charitable Institutions. * In the Book of Entry of Patients to be kept in a Licensed House, the Name, Occupation, and Place of Abode of the Person by whom such Patient shall be brought, must be entered. And in the Register to be kept by the Clerk of the Commissioners, or Clerk of the Peace, the name of the Proprietor or resident Superintendent, and of the Licensed House in which the Patient is confined, must be added. SCHEDULE (N.) FORM OF SUMMONS. WE whose Names are hereunto set and Seals affixed [Commissioners, or Visitors] appointed under and by virtue of an Act of Parliament made and passed in the second year of the reign of His present Majesty, intituled, "An Act for regulating the Care "and Treatment of Insane Persons in England," Do hereby summon and require you personally to appear before us at noon of the same day, and then and there to be examined and testify the truth touching certain matters relating to the execution of the said Act. |