(3)where an Order made by the Minister under Section 32 of the Act is not in force.) INFECTIOUS DISEASES REGULATIONS, 1948. VACCINATION AGAINST SMALLPOX. Ref. No.......... Office of the County/City Medical Officer. ...........................................................(Address). ........................................................ ...........................................................(Date). To

(1)...................................................... ............................................................ .................. ............................................................ .................. Your child

(2)........................................ is now at an age when he/she should be vaccinated against smallpox. You are accordingly requested to submit the child for vaccination at

(3).................... on

(4)........................................ at

(5).................... You need not comply with this request, if, before the time stated above, you send to me— (

1. a)a statement in writing to the effect that you object to the submission of your child to this vaccination or that the child's state of health is such that you consider that it would not be proper to vaccinate him or her now, or (
2. b)a statement in writing, signed by a medical practitioner, to the effect that the child has been vaccinated within the last three years or that two attempted vaccinations in the child have been unsuccessful. If your child is in attendance at the place mentioned above at or about the time stated, and if a statement as mentioned above has not been received by me you will be deemed to have submitted such child for vaccination. You are entitled to be present at the vaccination if you so wish. ............................................................ .............................

(6)....................County/City Medical Officer.

(1)Name and address of parent.

(2)Name of child.

(3)Place

(4)Day and date.

(5)Time.

(6)Name of County or City. Form B. Article 24. (

(1)............................................. ............................................................ ......... The Minister for Health has made an Order entitled

(2).................... under Section 32 of the Health Act, 1947 , declaring that it is necessary for the purpose of preventing the spread of smallpox that

(3)........................................ Your child

(4)........................................is covered by this Order and you are accordingly requested to submit him/her for vaccination at

(5)........................................ on

(6).................... at

(7).................... You need not comply with this request if you send to me, before the time stated, a statement in writing, signed by a medical practitioner, to the effect that :— (

1. a)the child has been vaccinated within the last three years ; or (
2. b)two attempted vaccinations in the child have been unsuccessful ; or (
3. c)the child's state of health is such that it would not be proper to vaccinate him or her now. Otherwise you will be liable to the penalties provided for in Section 31 of the Health Act, 1947 , if you do not comply with the request. If your child is in attendance at the place mentioned above at or about the time stated, and a statement as mentioned above has not been received by me, you will be deemed to have submitted such child for vaccination. You are entitled to be present at the vaccination if you so wish. ............................................................ ................

(8)....................County/City Medical Officer.

(1)Name and address of parent.

(2)Title of order.

(3)Such words as the Minister may specify when the Order is made should be inserted here.

(4)Name of child.

(5)Place.

(6)Day and date.

(7)Time.

(8)Name of county or city. Article 25. Form C. (

(3)where an Order made by the Minister under Section 32 of the Act is not in force.) INFECTIOUS DISEASES REGULATIONS, 1948. Immunisation against Diphtheria. Ref. No.................... Office of the County /City Medical Officer. Office of the County/City Medical Officer. ......................................................(Address). ................................................. .....................................................(Date). To

(1)............................................ ............................................................ ........ ............................................................ ........ Your child

(2)........................................ is now at an age when he/she should be immunised against diphtheria. You are accordingly requested to submit the child for immunisation at

(3)............................................................ on

(4)............................................................ .... at

(5)............................................... You need not comply with this request if, before the time stated above you send to me :— (

1. a)a statement in writing to the effect that you object to the submission of your child to this immunisation or that the child's state of health is such that you consider that it would not be proper to immunise him or her now ; or (
2. b)a statement in writing, signed by a medical practitioner, to the effect that the child has completed a course of immunisation within the last five years. If your child is in attendance at the place mentioned above at or about the time stated and a statement as mentioned above has not been received by me, you will be deemed to have submitted such child for immunisation. You are entitled to be present at the immunisation if you so wish. ............................................................ ................

(6)....................County/City Medical Officer,

(1)Name and address of parent.

(2)Name of child.

(3)Place.

(4)Day and date or days and dates.

(5)Time or times.

(6)Name of county or city. Article 25. Form D. (

(3)where an Order has been made by the Minister under Section 32 of the Act.) INFECTIOUS DISEASE REGULATIONS, 1948. IMMUNISATION AGAINST DIPHTHERIA. Ref. No.................... Office of the County/City Medical Officer. .......................................................(Address). .................................................. ......................................................(Date). To

(1).................................................. ............................................................ .............. ............................................................ .............. The Minister for Health has made an Order entitled

(2)........................................ under Section 32 of the Health Act, 1947 , declaring that it is necessary for the purpose of preventing the spread of diphtheria that

(3)........................................ Your child

(4)........................................is covered by this Order and you are accordingly requested to submit him/her for immunisation at

(5)....................on

(6).................... at

(7).................... You need not comply with this request if you send to me before the time stated a statement in writing, signed by a medical practitioner, to the effect that :— (

1. a)the child has completed a course of immunisation within the last five years ; or (
2. b)the child's state of health is such that it would not be proper to immunise him or her now. Otherwise you will be liable to the penalties provided for in Section 31 of the Health Act, 1947 , if you do not comply with the request. If your child is in attendance at the place mentioned above at or about the time stated and a statement as mentioned above has not been received by me, you will be deemed to have submitted such child for immunisation. You are entitled to be present at the immunisation if you so wish. ............................................................ ...

(8)....................County/City Medical Officer.

(1)Name and address of parent.

(2)Title of Order.

(3)Such words as the Minister may specify when the Order is made should be inserted here.

(4)Name of child.

(5)Place.

(6)Day and date or days and dates.

(7)Time or times

(8)Name of county or city. FOURTH SCHEDULE. FORMS PRESCRIBED FOR NOTIFICATIONS. Form A. Article 28. Counterfoil Form A Confidential Form A. INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 28) INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 28) NOTIFICATION To: The ............................................County/City Patient's Name............................................................ . Medical Officer. Address............................................................ .......... NOTIFICATION ............................................................ .......................... Patient's Name...................................................... Age..........Sex............... Address............................................................ ..... Disease............................................................ ............ Age..........Sex................ Datenotified............................................................ .. Occupation and Place of Employment ............................................................ ..................... ............................................................ ....................... Infectious Disease................................................ (

1. a)Disease diagnosed/ Disease suspected/carrier/suspected carrier. Tear off here Date of onset of disease or first appearance of symptoms........................ Patient has been removed to (name institution, if any)........................ I declare that in my opinion the above information is correct. (Signed)............................................................ Medical Practitioner. Date............................................................ . Address...................................................... (
2. a)The appropriate heading should be marked by an x above it. FORM B. Article 29. Counterfoil Form A Confidential Form B. INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 29) INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 29) Notification To: The..........................................County/City Medical Officer. Patient's Name................................................. Notification Address............................................ Hospital........................................... Age..........Sex............... Patient's Name......................................... Disease.......................................... Address................................................. Notified in respect

(1),

(2),

(3)Age..........Sex............... ............................................................ ............... Occupation and place of employment Date notified........................................................... ............................................................ ..... Tear off here Date .............................. Date of onset of disease or first appearance of symptoms..........................................

1. Patient who was admitted to the hospital as a case of suspected infectious disease without any definite diagnosis, is in my opinion suffering from (a).........................................
2. Patient who, before admission, was diagnosed to be suffering from....................................is in my opinion suffering from (a)................................
3. Patient is suffering from..............................which he contracted while in this institution. I declare that, in my opinion, the above information is correct. (Signed)............................................................ . Medical Officer Address................................................... ............................................................ ....... ............................................................ ...... (a) Insert " no infection disease " if appropriate. Cross out headings not applicable. FORM C. Article
4. Counterfoil Form C. Confidential Form C INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 30) INFECTIOUS DISEASE REGULATIONS, 1948 (ARTICLE 30) Notification To: The.................................County/City Medical Officer. Malaria induced for therapeutic purposes. Notification Patient's name............................................. Malaria induced for therapeutic purposes. Proposed Residence.................................. I hereby certify and declare that Age..........Sex.......... ............................................................ ....... Date of induction of disease............ at present in................................................ and due for discharge on.............................. Date of discharge........................ ............................................................ ..................... Observations........................................................... who proposes to reside at...................................... ............................................................ ...................... ............................................................ ................ ............................................................ ................... Tear off here has suffered from malaria induced for therapeutic purposes and in my opinion may be regarded as liable to be attacked by relapses of that disease. Patient's Age............Sex............... Date of induction of the disease ............................................................ ................. Observations (Notes on clinical course of disease and form of treatment employed).................... ............................................................ ................... ............................................................ ................... (Signed)....................................... Medical Practitioner. Date............................................................ ........ Address............................................................ ............................................................ ......... FORM D. Article Counterfoil Form D. Confidential Form D. INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 28) INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 28) Notification. To: The..................County/City Medical Officer. Case of acute anterior poliomyelitis leaving institution. Notification. Patient's name...................................................... Case of acute anterior poliomyelitis leaving institution. Address............................................................ ... Patient's name.................... ............................................................ ................... Address at which patient proposes to ............................................................ ................... reside............................................................ ................. Age..........Sex............... ............................................................ ................... Age..........Sex.................... Date of discharge........................ Date of proposed discharge.................................. Observations......................... Observations on present condition of ............................................................ ................... the patient............................................................ .... ............................................................ ................... ............................................................ ................... Tear off here ............................................................ ................... ............................................................ ................... I declare that, in my opinion, the above information is correct. (Signed)........................................................... Medical Practitioner. Date............................................................ ................... Address............................................................ ............. ............................................................ ................... FORM E. Article
5. Counterfoil. Form E. Confidential. Form E. INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 33). INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 33). NOTIFICATION OF TUBERCULOSIS. To: The..................................................County/City Medical Officer. Patient's name.......................................... Address................................................... NOTIFICATION OF TUBERCULOSIS. Age............Sex........................ Address............................................................ ......... Date of examination............................................. ............................................................ ........................ Date notified......................................................... Age...............Sex........................ Observations :..................................................... Occupation and place of employment ............................................................ ................... ............................................................ . ............................................................ ................... Date of examination........................ ............................................................ ................... Suffering from pulmonary/non-pulmonary tuberculosis. Tear off here Medical Condition............................................. ............................................................ ................... Nature of attention required under the Tuberculosis Scheme............................ ............................................................ ................... ............................................................ ................... I declare that, in my opinion, the above information is correct. Signed........................................... Medical Practitioner Date............................................. Address............................................................ ... ............................................................ ................... FORM F. Article
6. Counterfoil. Form F. Confidential. Form F. INFECTIOUS DISEASES REGULATIONS, 1948 (ARTICLE 34). INFECTIOUS DISEASES REGULATIONS,
7. (ARTICLE 34). INTIMATION OF SUSPECTED CASE OF TUBERCULOSIS To: The................................................County/City Medical Officer. INTIMATION OF SUSPECTED CASE OF TUBERCULOSIS. Patient's name.............................. I hereby declare that I have examined Address............................................................ .............. the patient named below and I suspect that this patient may be suffering from ............................................................ ................... pulmonary/non-pulmonary tuberculosis. Age............Sex........................ Patient's name................................. Date of examination.................................................... Address............................................................ . Particulars of Disease :................................................ ............................................................ ................... ............................................................ ................... ............................................................ ................... Age............Sex........................... ............................................................ .................... Occupation and place of employment Date of intimation....................................................... ............................................................ ................... Confidential report received on Medical condition and symptoms ............................................................ ................... ............................................................ ................... ............................................................ ................... Confirmed. I should be grateful if this patient Not confirmed. could be specially examined for Tear off here. Tuberculosis and a confidential report sent to me. Attendance at a Tuberculosis Clinic can/cannot be arranged. Signed .................... Medical Practitioner. Date............................................................ ........... Address............................................................ .... ............................................................ ................... For Office Use. ARTICLE
8. FORMS G. 1 and FORMS G. 1 and G.
9. Tear off here CONFIDENTIAL. FORM G.
10. Tear off here CONFIDENTIAL. FORM G.
11. COUNTERFOIL. INFECTIOUS DISEASES REGULATIONS, INFECTIOUS DISEASES REGULATIONS INFECTIOUS DISEASES REGULATIONS,
14. (ARTICLE 35.) (ARTICLE 35). (ARTICLE 35.) To: The .............................................County/City Medical Officer. To: The.......................................County/City Medical Officer. NOTIFICATION OF VENEREAL DISEASE. REPORT ON CASE OF VENEREAL NOTIFICATION OF VENEREAL Patient's name............................................... DISEASE NOTIFIED. DISEASE. Address ........................................................ Identification number of case.............................. I hereby certify that I have on..................... ......................................... 19..........., diagnosed a case of gonorrhœa/syphilis/soft chancre. ............................................................ ............ Disease............................................................ ........ Identification No.......................................... Patient has: Pathological report is herewith/as follows: Disease..........................................................

(1)Satisfactorily completed course of treatment. ............................................................ ............. Date diagnosed............................................

(2)Undergone part only of course of treatment and I am of opinion that he is ............................................................ ............. Pathological Report.....................................

(3)Gone to live in (a)............................................. I have made arrangements as follows for the treatment of this case............................ ............................................................ ............

(4)Died. ............................................................ ............ Arrangements for treatment...................... If patient has not completed course of treatment, give opinion as to why he did not The identificatin number of the case is ............................................................ ............ ............................................................ ..................... ............................................................ ............................................................ ............ Observations ........................................................ (Signed) ........................................................... Medical Practitioner. Date notified................................................. Address ......................................................... Date of Report on Form G. 2....................... (Signed) ............................................................ ........ Medical Practitioner. Date............................................................ .... ............................................................ ............. Address ............................................................ ..... Date............................................................ ............. (a) Insert name of town or townland and county. GIVEN under the Official Seal of the Minister for Health, this twenty-fourth day of March, One Thousand Nine Hundred and Forty-eight. (Signed) NOÉL C. BROWNE, Minister for Health. The Minister for Finance hereby consents to the enforcement and execution of Articles 20 and 22 of these Regulations by officers of Customs and Excise. (Signed) J. J. McELLIGOTT, Secretary, Department of Finance. GIVEN under the Official Seal of the Minister for Finance, this twenty-fourth day of March, One Thousand Nine Hundred and Forty-eight. Privacy Statement Accessibility European Legislation Identifier (PDF) Open Data License Ráiteas Príobháideachais Inrochtaineacht Aitheantóir Eorpach Reachtaíochta (ELI) Ceadúnas Sonraí Oscailte Liosta Fianán © Government of Ireland. Oireachtas Copyright Material is reproduced with the permission of the Houses of the Oireachtas © Rialtas na hÉireann. Atáirgtear ábhar faoi Chóipcheart le cead ó Thithe an Oireachtais