" hospital services " does not include a service given by a member of the staff of a hospital under an arrangement made under article 6 or article 7 of these Regulations ;

" midwife, " " nurse" and " nursing " have the same meanings as in the Nurses Act, 1950 (No. 27 of 1950) ;

" specialist services " does not include the giving of any drug, medicine or other preparation which is not administered to the patient direct by a person giving such service.

3 Commencement.

3. These Regulations shall come into operation on 1st day of August, 1954.

4 Revocation.

4. The Mother and Child Health Service (Temporary) Regulations, 1948 ( S.I. No. 100 of 1948 ) are hereby revoked.

5 Records and confidential nature or documents.

5.—(1) A health authority and their officers shall keep such records as may be specified by the Minister from time to time or, in the absence of such specification, as may be determined by the health authority, in relation to the services made available in accordance with these Regulations.

(2) Any records kept in pursuance of this article shall be treated in a confidential manner and shall be available for inspection by persons authorised by the health authority or by the Minister and by no other persons.

(3) When any record, claim, application, report or other communication relating to the giving of services to an individual person in accordance with these Regulations is sent by post, it shall be enclosed in a sealed envelope.

(4) A document which is obtained or compiled under these Regulations (or a part of, or an extract from, such a document) which contains the name of an individual person shall not be published save with the consent in writing of such person.

PART II. MEDICAL, ETC., CARE FOR MOTHERS AND INFANTS.

Chapter I.

—General Medical Services.

6 Medical care for mothers.

6.—(1) A health authority shall make available the services under section 16 of the act for the provision of maternity medical services for women in respect of motherhood—

(a) by making agreements, in accordance with regulations made by the Minister, with registered medical practitioners for the provision of such services and

(b) where the health authority think fit, by—

(i) arranging, with the consent of the Minister, for the provision of such services through medical officers of any health institution in which instruction is given to persons being trained to become registered medical practitioners or nurses, or

(ii) making arrangements, with the consent of the Minister, with other hospitals for the provision of such services.

(2) Any woman entitled to receive the services referred to in this Article may receive them, at her choice, from any medical practitioner or hospital authority having an agreement with the health authority for the provision of those services and willing to accept her as a patient.

7 Infant welfare services.

7.—(1) A health authority shall make available medical and surgical services under section 17 of the Act for children up to the age of six weeks whose mothers are entitled to avail themselves of the services under section 16 of the Act—

(a) by making agreements, in accordance with regulations made by the Minister, with registered medical practitioners for the provision of such services, and

(b) where the health authority think fit, by—

(i) arranging, with the consent of the Minister, for the provision of such services through medical officers of any health institution in whichinstruction is given to persons being trained to become registered medical practitioners or nurses, or

(ii) making arrangements, with the consent of the Minister, with other hospitals for the provision of such services.

(2) The services referred to in this article shall be made available for a child at the choice of the parent by any medical practitioner or hospital authority having an agreement with the health authority for the provision of those services and willing to accept the child as a patient.

8 Making of agreements.

8.—(1) A health authority shall, on application being made to them, enter into an agreement in a form prescribed in regulations made by the Minister or in a form substantially to the like effect with any registered medical practitioner (whether resident in the functional area of the health authority or not) for the provision of services under section 16 or section 17 or sections 16 and 17 (as may be appropriate) of the Act, unless:—

(a) the medical practitioner is employed in a wholetime capacity in the service of the State or of a local authority, or

(b) by reason of previous breaches by him of an agreement under this article with the health authority or any other health authority, the health authority consider that it is not desirable to enter into an agreement with the medical practitioner.

9 Lists of participating medical practitioners

9. A health authority shall from time to time prepare a list of the medical practitioners with whom they have agreements and of the hospitals (if any) with which they have arrangements in operation under this Chapter of this Part of these Regulations and shall make available to any person who requests it a copy of the list.

10 Applications for services.

10.—(1) There shall be completed by or on behalf of a woman desiring to avail herself of the service referred to in article 6 of these Regulations in respect of a pregnancy or on behalf of a child for whom it is desired that there be available the services referred to in article 7 of these Regulations, an application for such services in the form (Form MCA) in the Schedule to these Regulations or in a form substantially to the like effect.

(2) Only one application under this article (whether to a medical practitioner or to a hospital) may be made in respect of a particular pregnancy except where the health authority otherwise agree.

(3) Only one application under this article (whether to a medical practitioner or to a hospital) may be made in respect of a particular child, except where the health authority otherwise agree.

(4) An application completed under this article shall be sent to the medical practitioner or hospital authority selected to provide the service and such practitioner or authority, if willing to accept the woman or child as a patient, shall, within two weeks of its receipt send the application to the health authority responsible for making the service available for the applicant, together with an undertaking to provide the service.

(5) The health authority shall, as soon as may be, notify the applicant and the medical practitioner or hospital authority of their decision on an application under this article.

(6) Where a decision by a health authority on an application under this article is to the effect that the yearly means of an adult person are not less than six hundred pounds, they shall notify the applicant of his right of appeal under subsection (9) of section 15 of the Act, giving particulars of the person to whom and the time within which the appeal may be made.

11 Extra professional assistance.

11.—(1) Whenever in the course of attendance by a medical practitioner on a woman or child in pursuance of an agreement made by him with a health authority for the purposes of section 16 or section 17 of the Act, circumstances arise which, in his opinion, necessitate his obtaining the assistance of another registered medical practitioner, he may, on his own authority, summon the assistance of such other practitioner and shall thereupon report the circumstances in writing to the health authority.

(2) If the health authority, on consideration of a report made under sub-article (1) of this article, are satisfied that the summoning of the second medical practitioner was necessary, they shall pay to such medical practitioner such fee as may be approved of or directed by the Minister.

12 Claims for payment.

12. When the giving of services in any particular case has been completed under this Chapter of this Part of these Regulations by a medical practitioner or by the authority of a hospital which is not a health institution, such practitioner or authority shall furnish to the chief medical officer of the health authority a claim for payment in respect of the services and the completed record card relating to the case.

13 Obstetrical requisites.

13.—(1) The obstetrical requisites which a health authority shall make available to a woman entitled to such requisites under subsection (5) of section 16 of the act shall be—

(a) (i) twenty-four ounces of gauze and cotton tissues,

(ii) eight ounces of absorbent cotton wool,

(iii) one ounce of absorbent lint,

(iv) one four-ounce bottle of antiseptic fluid of a suitable type, and

(b) such other obstetrical requisites as may be specified by the Minister from time to time and as may be certified to benecessary for the woman by the appropriate registered medical practitioner providing services under article 6 of these Regulations in respect of the period commencing at the onset of labour and ending fourteen days after its termination.

Chapter II.

—Midwifery and Nursing Services.

14 Midwifery services.

14. A health authority shall make midwifery services available under section 16 of the Act—

(a) through midwives who are officers of the health authority ;

(b) by making, with the consent of the Minister, arrangements for the provision of such services by other midwives.

15 Nursing services for infants.

15. A health authority shall make nursing services available under section 17 of the Act—

(a) through nurses who are officers of the health authority ;

(b) by making, with the consent of the Minister, arrangements for the provision of such services by other nurses.

Chapter III.

—Institutional and Specialist Services.

16 Manner of making hospital services available.

16.—(1) Hospital services under section 16 or section 17 of the Act may be made available by a health authority—

(a) by providing such services in the health institutions maintained by that authority ;

(b) by making arrangements under section 10 of the Act for the provision of such services in other institutions.

(2) Except in a case of urgent necessity, hospital services shall not be made available under section 16 or section 17 of the Act, save where the person, to obtain the services, is referred for such services by a registered medical practitioner.

17 Applications for hospital services.

17.—(1) There shall be completed by or on behalf of a woman desiring to avail herself of, or on behalf of a child for whom it is desired that there be available, hospital services under section 16 or section 17 of the Act and who is not being attended at the time by a medical practitioner or midwife under an agreement made in accordance with article 8 or article 14 of these Regulations, an application for such services in the form (Form MCB) in the Schedule to these Regulations or in a form substantially to the like effect.

(2) A health authority may, if otherwise satisfied in relation to the entitlement of a person or persons to such services, dispense with the requirement in sub-article (1) of this article in respect of a particular person or a particular class of persons.

(3) An application completed under this article shall be sent to the health authority responsible for making the services available to the woman or child and, if the application is refused, that authority shall, as soon as may be, notify the applicant of the refusal.

(4) Where a decision by a health authority on an application made under this article is to the effect that the yearly means of a person are not less than six hundred pounds, they shall notify the applicant of his right of appeal under subsection (9) of section 15 of the Act, giving particulars of the person to whom and the time within which the appeal may be made.

(5) Where an application under this article is refused and the person by or on behalf of whom the application was made is to be or, since making the application, has been maintained in an institution not managed by the health authority, the health authority shall, as soon as may be, notify the authority or person managing the institution of the refusal.

18 Admissions to health institution.

18.—(1) A woman entitled to hospital services under section 16 of the Act, may be admitted to an appropriate health institution by the appropriate medical officer, matron or head nurse—

(a) where she is referred for hospital services by a registered medical practitioner, or

(b) in a case of urgent necessity, where she is not so referred.

(2) A child who is entitled to hospital services under section 17 of the Act, may be admitted to an appropriate health institution by the appropriate medical officer, matron or head nurse—

(a) on the statement of a registered medical practitioner that the child is in need of hospital services, or

(b) in any case of urgent necessity, without such a statement.

(3) Where a person is admitted to a health institution in accordance with this article and an application under article 17 of these Regulations has not already been completed on behalf of the person, such an application, if it is required under article 17 of these Regulations, shall be completed and transmitted to the appropriate health authority as soon as may be after the person is admitted to the institution.

(4) This article shall not apply in relation to a woman or a child sent to a health institution from another health institution in which such woman or child has received institutional services.

19 Notification of admission to extern institution.

19. Where under an arrangement made under section 10 of the Act, a person is admitted to an institution for the provision of hospital services under section 16 or section 17 of the Act and the admission of that person has not been arranged by the health authority or by a medical practitioner providing services in accordance with article 6 or article 7 of these Regulations, the person in charge of the institution shall within three days, or such longer period as may be agreed to, notify the health authority of his admission in the form (Form MCC) in the Schedule to these Regulations or in a forth substantially to the like effect.

20 Payments under section 25 of the Act.

20.—(1) The making of a payment by a health authority under section 25 of the Act, in respect of a woman or child entitled to institutional services under section 16 or section 17 of the Act shall be subject to the following conditions :—

(a) the person in charge of the institution shall, within three days of the admission of the person to the institution or within such longer period as may be agreed upon with the health authority, notify the health authority of his admission in the form (Form MCC) in the Schedule to these Regulations, or in a form substantially to the like effect,

(b) the person in charge of the institution shall ensure that, in a case where it is required under article 17 of these Regulations, an application in the form (Form MCB) in the Schedule to these Regulations, or in a form substantially to the like effect, completed by or on behalf of the person, and shall be sent to the health authority on the admission of the person to the institution ;

(c) the claim for payment shall be made to the health authority in the form (Form ISC) in the Schedule to the General Institutional and Specialist Services Regulations, 1954 at such intervals as may be determined by the health authority.

(2) A health authority shall, as soon as may be, after receiving a notification and application under sub-article (1) of this article notify the institution and the applicant of the refusal of any application.

(3) Where a decision by a health authority on an application under this article is to the effect that the yearly means of a person are not less than six hundred pounds, they shall notify the applicant of his right of appeal under subsection (9) of section 15 of the Act, giving particulars of the person to whom and the time within which an appeal may be made.

21 Manner of making specialist services available.

21.—(1) Specialist services may be made available by a health authority under sections 16 and 17 of the Act through their own officers or by making arrangements with an institution or person for the giving of such services.

(2) Specialist services shall not be made available in accordance with this article save where the person to obtain the services is recommended for such services by a registered medical practitioner.

(3) Specialist services under this article shall not include the supply of appliances, drugs, medicines or other preparations save to such extent as may be approved of or directed by the Minister.

22 Application for specialist service.

22.—(1) There shall be completed by or on behalf of a woman desiring to avail herself of, or on behalf of a child for whom it is desired that there should be available, specialist services under section 16 or section 17 of the Act and who is not being attended at the time by a medical practitioner or midwife under an agreement made in accordance with article 8 or article 14 of these Regulations, an application for such services in the form (Form MCB) in the Schedule to these Regulations or in a form substantially to the like effect.

(2) A health authority may, if otherwise satisfied in relation to the entitlement of a person or persons to specialist services under these Regulations, dispense with the requirement in sub-article (1) of this article in respect of a particular person or a particular class of persons.

(3) An application completed under this article shall be sent to the health authority responsible for making the services available to the applicant and, if the application is refused, that authority shall,

(a) notify the applicant of the refusal and

(b) if the applicant has availed himself of any service, notify him of the charge for the service under section 30 of the Act.

Chapter IV.

—Contributions under Section 16 (2) of the Act.

23 Amount of contribution.

23.—(1) Contributions for the purposes of subsection (2) of section 16 of the Act shall be at the rate of the appropriate amount for each year (not being a year before marriage) in respect of which a contribution is payable in accordance with these Regulations.

(2) Subject to the provisions of sub-article (3) of this article the appropriate amount for the purpose of sub-article (1) of this article shall be one pound.

(3) The appropriate amount for the purpose of sub-article (1) of this article shall for each successive period of five years (the first of such periods being the period of five years beginning on the day after the expiration of three years from the commencement of section 16 of the Act or such later day as the Minister may determine to be the earliest practicable day for the beginning of such periods), be—

(a) for persons other than persons who have paid a contribution in respect of the year immediately preceding such period, either—

(i) such amount as may be fixed by the Minister for that period as the amount which will result in obtaining by contributions approximately one-halfof the estimated cost, as determined by the Minister, during such period of the provision of services for women by or on behalf of whom contributions at the rate fixed under this subparagraph are paid, or

(ii) two pounds,

whichever is the less, and

(b) for persons who have paid a contribution in respect of the year immediately preceding such period, the amount payable by that person for that year or the amount fixed by the Minister as aforesaid, whichever is the less.

24 Number of contributions required for entitlement to services.

24.—(1) In the case of a woman married before the commencement of section 16 of the Act and to whom sub-article (3) of this article does not apply, the contribution or contributions which, at any. time, shall be required to have been made for the purpose of paragraph (b) of subsection (2) of section 16 of the Act shall be either—

(a) (i) a contribution, paid before the commencement of such year, in respect of a year commencing on a date not later than six months after the commencement of section 16 or if the woman is confined within that six months, commencing before the confinement and

(ii) a contribution in respect of each subsequent year, paid not later than two months after the commencement of such year, or

(b) (i) a contribution, paid before the commencement of such year, in respect of a year commencing on a date not less than twelve months earlier than the expected date of the confinement in respect of which the woman wishes to be entitled to avail herself of services under section 16 of the Act, and

(ii) a contribution in respect of each subsequent year, paid not later than two months after the commencement of such year.

(2) In the case of a woman married after the commencement of section 16 of the Act and to whom sub-article (3) of this article does not apply, the contribution or contributions which, at any time, shall be required to have been made for the purposes of paragraph (b) of subsection (2) of section 16 of the act shall be either—

(a) (i) a contribution, paid before the commencement of such year, in respect of a year commencing on a date not later than six months after the commencement of section 16 of the Act or three months after the date of her marriage, whichever is the later, and

(ii) a contribution in respect of each subsequent year, paid not later than two months after the commencement of such year, or

(b) (i) a contribution paid before the commencement of such year, in respect of a year commencing on a date not less than twelve months earlier than the expected date of the confinement in respect of which the woman wishes to be entitled to avail herself of services under section 16 of the Act and

(ii) a contribution in respect of each subsequent year paid not later than two months after the commencement of such year.

(3) In the case of a woman who, having, on or after the commencement of section 16 of the Act, been in the class referred to in paragraph (a) of subsection (2) of section 16 of the Act, ceases to be in that class, the contribution or contributions which, at any time, shall be required to have been made for the purposes of paragraph (b) of the said subsection shall be either—

(a) (i) a contribution, paid before the commencement of such year, in respect of a year commencing on a date not later than six months after the date on which she ceases to be in that class or, if the woman is confined within that six months, before the confinement, and

(ii) a contribution in respect of each subsequent year paid not later than two months after the commencement of such year, or

(ii) a contribution in respect of each subsequent year paid not later than two months after the commencement of such year.

25 Payment of contributions.

25. A contribution under this Chapter shall be paid to the health authority in whose functional area the woman by or on behalf of whom it is payable is normally resident when the payment falls due.

26 Change of residence.

26. Where a woman by or on behalf of whom a contribution has been paid under this article becomes normally resident in the functional area of a health authority other than the authority to whom the contribution was paid—

(a) the entitlement of the woman to avail herself of services under section 16 of the act shall not be thereby affected and

(b) any subsequent contributions paid by or on behalf of the woman shall be paid to the health authority in whose functional area she is then resident.

PART III. CHILD WELFARE SERVICES.

27 Places where clinics are to be provided.

27. Services under section 18 of the act—

(a) shall be made available as soon as is practicable after the commencement of these Regulations in each town in which there is a population of three thousand or more, and

(b) may be made available in other places.

28 Attendance of medical practitioners etc.

28. For the purpose of making services under section 18 of the act available, arrangements shall be made—

(a) for the attendance of a registered medical practitioner at each appropriate institution at fixed times ;

(b) for the provision of such ancillary nursing services as may be required.

PART IV. SCHOOL HEALTH EXAMINATION AND TREATMENT SERVICE.

29 Manner of making service available.

29. A health authority, for the purpose of making available the service mentioned in section 19 of the act—

(a) shall, subject to article 31 of these Regulations arrange for the periodical attendance of a registered medical practitioner and may arrange for the periodical attendance of a registered dentist for the examination of the pupils attending each school in their functional area to which section 19 of the act for the time being applies, and

(b) shall arrange for the provision of such nursing services as may be required (including services given at the homes of pupils) and may arrange for the provision of other ancillary services.

30 Services to be made available.

30.—(1) Subject to sub-article (2) of this article and to article 31 of these Regulations the services to be made available under section 19 of the act shall include the health examination of a pupil—

(i) as soon as may be after he has commenced to attend school,

(ii) as near as may be to the time when he reaches the age of ten years,

(iii) as near as may be before the time when it is expected that he will cease to attend a school to which section 19 of the act applies, or, in the case of a girl, before the time when she will reach the age of fourteen years, and

(iv) at such other times as such an examination may be considered desirable.

(2) A health examination (other than an examination to ascertain defects of the eye, ear, nose or throat or the teeth) shall be provided under section 19 of the act in the case of a girl who has reached the age of fourteen years only on the request, in writing, of the parent of the child and, when the examination is conducted by a person who is not a female person, it shall be conducted only in the presence of an adult female person.

31 Services in schools attached to hospitals, etc.

31. The services to be made available under section 19 of the act in the case of a school which is provided for the patients in a hospital, sanatorium, convalescent home, preventorium or similar institution shall be such services as the health authority think necessary, having regard to the services already provided in the institution.

32 Co-operation with school authorities.

32. In the making of services available in accordance with this Part of these Regulations the convenience of the manager and teaching staff of the school shall be suited and the minimum possible interference with, or disturbance of, the school arrangements shall be caused.

PART V. DENTAL, OPHTHALMIC AND AURAL SERVICES FOR CHILDREN.

33 Manner of making dental ophthalmic and aural services available for children.

33. Dental, ophthalmic and aural treatment and dental, optical and aural appliances shall be made available by a health authority under section 20 of the act—

(a) through appropriately qualified officers of the health authority,

(b) through other appropriately qualified persons under arrangements made by the health authority, with the consent of the Minister.

SCHEDULE.

FORM MCA HEALTH ACT, 1953 . Confidential

MEDICAL AND SURGICAL SERVICES FOR MOTHERS AND INFANTS.

APPLICATION FOR MEDICAL SERVICES.

TO BE COMPLETED BY THE APPLICANT.

I*""............................................................ of*............................................................ .........in the County/

County Borough

of........................................................hereby apply to you to

(a)†"" accept me for medical and surgical services in respect of motherhood

(b)† provide medical and surgical services for my infant

under and in accordance with the provisions of the Health Act, 1953 , and the Regulations made under that Act.

Particulars in relation to my entitlement are overleaf.

I certify that these particulars are, to the best of my knowledge, accurate and complete and that I have not made arrangements for these services with another medical practitioner.

Signature of applicant..............................

Date........................................................

To Dr................................................

N.B.—Knowingly to make any false statement or conceal any material fact in making this application is an offence punishable by a fine of £50 or by three months imprisonment, or both.

*Name and address IN BLOCK LETTERS

†Delete if not applicable.

_______________________________________________________________________

TO BE COMPLETED BY THE DOCTOR.

I undertake to provide medical and surgical services

(a)‡""for the person named above

(b)‡ for the infant

in accordance with the conditions laid down in the agreement made between me and the health authority for the provision of such services.

The expected date of confinement is............................................. 19......

To the Secretary..............................................County Council

,, ,, City Manager and Town Clerk.......................................................

Signed............................................................ ...........................

Address............................................................ ...............

Date............................................................ ...

_______________________________________________________________________

For Use in the Health Authority's office.

‡Delete if not applicable.

PARTICULARS AS TO ENTITLEMENT.

PART I.—TO BE COMPLETED WHERE THE APPLICANT (OR HER HUSBAND) IS THE HOLDER OF A MEDICAL CARD UNDER THE GENERAL MEDICAL SERVICES REGULATIONS, 1954.

In whose name was the card issued ?............................................................ .................................................

Number of card............................................................ ............................................................ ................................

PART II.—TO BE COMPLETED BY PERSONS IN RESPECT OF WHOM CONTRIBUTIONS UNDER SECTION 16 of THE HEALTH ACT, 1953 , HAVE BEEN PAID FOR MATERNITY AND INFANT SERVICES.

Date of payment of last annual contribution............................................................ .....................................

or number of receipt issued by the health authority for such a contribution..............................................

N.B.—Where Part I or Part II has been completed, the remaining Parts of this Form may be ignored.

PART III.—TO BE COMPLETED WHERE THE APPLICANT OR HER HUSBAND IS INSURED UNDER THE SOCIAL WELFARE ACT, 1952 .

If the applicant is herself insured, her insurance number............................................................ .............

If she is not insured and her husband is, his name and insurance number.............................................

If you have completed Part III, the remaining Parts may be ignored.

PART IV.—TO BE COMPLETED WHERE THE APPLICANT'S (OR HER HUSBAND'S) MEANS ARE DERIVED WHOLLY OR MAINLY FROM FARMING.

Address (or addresses) of the farm or farms (including any held on an agreement for letting)......................................

............................................................ .........................................

Total rateable valuation (including buildings)............................................................ ..........................

Specify any other source of income* (Further particulars about this may be required later)............................................................ ............................................................ .............................................

* The income of the wife and of any unmarried son, daughter, stepson or stepdaughter normally resident with the applicant should be included.

If you have completed Part IV, the remaining Part may be ignored.

PART V.—TO BE COMPLETED ONLY WHERE THE APPLICANT IS NOT A PERSON COVERED BY PART I, II, III OR IV ABOVE.

Note—Further particulars as to the means of an applicant completing this aPrt of the Form may be required later.

1. What is the precise occupation of
(a) the applicant?	............................................................ .....
(b) the wife or husband of the applicant ?	............................................................ .....
(c) any other member of the family ?*	............................................................ .....
2. Does the applicant, or any other member of the family* own
(a) the dwelling house in which the family resides ?	............................................................ .....
(b) any other premises?	............................................................ .....
(c) any land or	............................................................ .....
(d) any property other than buildings or land (e.g. investments, cash in bank, etc.) value more than £25 ?
3. Is the applicant in receipt of
(a) an old age pension ?	............................................................ .....
(b) a widow's(non-contributory) pension ?	............................................................ .....
(c) unemployment assistance ?	............................................................ .....
If so, state the pension number	............................................................ .....
or the qualification certificate number	............................................................ .....
* " Family " for the purpose of this Form includes the applicant, his or her wife or husband and any unmarried son, daughter, stepson or stepdaughter normally resident in the home.

Form MCB. Confidential.

HEALTH ACT, 1953 .

MEDICAL CARE FOR MOTHERS AND INFANTS.

APPLICATION FOR INSTITUTIONAL OR SPECIALIST SERVICES.

I*...............................................of*........................................... in the County/County Borough of......................................................hereby apply for institutional and specialist services—

(a)† for myself in respect of motherhood, or

(b)† for my child who is under six weeks old.

Particulars in relation to my entitlement are overleaf.

I certify that these particulars are, to the best of my knowledge accurate, and complete.

Signature of applicant.....................................

Date.......................................................

To the....................................................County Council,

Corporation.

N.B. Knowingly to make any false statement or conceal any material fact in making this application is an offence punishable by a fine of £50 or by three months imprisonment, or both.

*Name and address IN BLOCK LETTERS.

†Delete if not applicable

_______________________________________________________________________

PARTICULARS AS TO ENTITLEMENT.

PART I.—TO BE COMPLETED WHERE THE APPLICANT (OR HER HUSBAND) IS THE HOLDER OF A MEDICAL CARD UNDER THE GENERAL MEDICAL SERVICES REGULATIONS, 1954.

In whose name was the card issued ? ............................................................ ..................................

Number of card............................................................ ............................................................ ....................

PART II.—TO BE COMPLETED BY PERSONS IN RESPECT OF WHOM CONTRIBUTIONS UNDER SECTION 16 of THE HEALTH ACT, 1953 , HAVE BEEN PAID FOR MATERNITY AND INFANT SERVICES.

Date of payment of last annual contribution............................................................ .............................................

or number of receipt issued by the health authority for such a contribution...........................

N.B.—Where Part I or Part II has been completed, the remaining Parts of this Form may be ignored.

PART III.—TO BE COMPLETED WHERE THE APPLICANT OR HER HUSBAND IS INSURED UNDER THE SOCIAL WELFARE ACT, 1952 .

If the applicant is herself insured, her insurance number...........................

If she is not insured and her husband is, his name and insurance number.............................................

If you have completed Part III, the remaining Parts may be ignored.

PART IV.—TO BE COMPLETED WHERE THE APPLICANT'S (OR HER HUSBAND'S) MEANS ARE DERIVED WHOLLY OR MAINLY FROM FARMING.

Address (or addresses) of the farm or farms (including any held on an agreement for letting)............................................................ ............................................................ ...................................

............................................................ ............................................................ ...........................................................

Total rateable valuation (including buildings)............................................................ ..........................................

* The income of the wife and of any unmarried son, daughter, stepson or stepdaughter normally resident with the applicant should be included.

If you have completed Part IV, the remaining Part may be ignored.

PART V.—TO BE COMPLETED ONLY WHERE THE APPLICANT IS NOT A PERSON COVERED BY PART I, II, III OR IV ABOVE.

Note.—Further particulars as to the means of an applicant completing this Part of the Form may be required later.

1. What is the precise occupation of
(a) the applicant ?	............................................................ ..........
(b) the wife or husband of the applicant ?	............................................................ .....
(c) any other member of the family ?*	............................................................ ..........
2. Does the applicant, or any other member of the family* own
(a) the dwelling house in which the family resides ?	............................................................ .........................
(b) any other premises ?	............................................................ ................
(c) any land or	............................................................ ..............
(d) any property other than buildings or land (e.g. investments, cash in bank, etc.) value more than £25 ?	............................................................ .......................
3. Is the applicant in receipt of
(a) an old age pension ?	............................................................ ..............
(b) a widow's(non-contributory) pension ?	............................................................ ..................
(c) unemployment assistance ?	............................................................ ................
If so, state the pension number	............................................................ ...........
or the qualification certificate number	............................................................ ...........
* " Family " for the purpose of this Form includes the applicant, his or her wife or husband and any unmarried son, daughter, stepson or stepdaughter normally resident in the home.

Confidential

Form Mcc.

HEALTH ACT, 1953 .

FORM OF NOTIFICATION OF ADMISSION TO INSTITUTION.

INSTITUTIONAL SERVICES FOR MOTHERS AND INFANTS.

Institution.......................................................

The following are particulars of a patient admitted to the above-mentioned institution in respect of whom it is proposed to claim payment from your authority under section 16, or section 17 or section 25* of the Health Act, 1953 :—

Name of Patient............................................................ ............................................................ .......

Ordinary Address............................................................ ............................................................ .......

............................................................ ............................................................ ..................................

Name and address of medical practitioner who referred the patient for institutional treatment............................................................ ..........................................................

............................................................ ............................................................ ................................

Date of admission of patient............................................................ ....................................

Expected duration of stay in institution............................................................ ...........................

Signed......................................................

Office.......................................................

Date ..........................................

To : the Secretary............................................................ ...........County Council.

To : the City Manager and Town Clerk....................................................

GIVEN under the Official Seal of the Minister for Health, this Fifteenth day of May, One Thousand Nine Hundred and Fifty-four.

SÉAMAS Ó RIAIN,

Minister for Health.

*Delete whichever is not applicable.