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DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH.
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No. 69380/1931.
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The Minister for Local Government and Public Health, in exercise of the powers vested in him by every County Scheme as confirmed or amended by or in pursuance of the Local Government (Temporary Provisions) Acts, 1923 and 1924, does hereby revoke so much of the Order made by the Minister for Local Government bearing date the 9th day of November, 1923, as prescribes the form (Form No. 2) of order for admission to a hospital and does hereby order and direct that every order for admission to a hospital under any such County Scheme shall be in the form set out in the Schedule hereto.
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GIVEN under the Official Seal of the Minister for Local Government and Public Health this Twelfth day of October, One Thousand Nine Hundred and Thirty-one.
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(Signed)RISTEÁRD UA MAOLCHATHA,
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Minister for Local Government and Public Health.
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SCHEDULE.
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FORM No. 2.
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Order for Admission to a Hospital.
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1............................................................ ............................................................ ...............
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To the Matron of the
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.............................................County
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Hospital.
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.............................................District
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I hereby certify that I have this day examined............................................................ ......
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......................................................... of............................................................ ................
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a person eligible for relief. In my opinion
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he
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is suffering
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she
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from............................................. and is in need of 2..........................................................
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treatment in a hospital.
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I therefore require you to admit
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him
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to the above-mentioned Hospital.
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her
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Signed............................................................ ...................
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Medical Officer of the 3............................................................ .....
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of the 1............................................................ ...........
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Date and time............................................................ .................................
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_________________________________________________________________________________institution.
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1 Here insert name of poor law authority.
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2 State if medical, surgical, obsteric, gynaecological, special, urgent.
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3 Here insert name of Dispensary District or institution.
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