 | Gold Coast, Sir William Brandford Griffith - 1898 - 768 pągines
...Statement. [If any particulars in this statement are -tiot known, this to be stated, ,] Name of patient and Christian name at length. Sex and age. Married, single...Condition of life and previous occupation, if any. The religious persuasion as far as known. Previous place of abode. Whether first attack. Age (if known)... | |
 | Victoria - 1904 - 526 pągines
...particulars reqidred in this statement be not known tfte Jact of such want of knowledge is to be so stated.] Name of patient with Christian name at length Sex and age Married single or widowed Number of children Age of youngest child Previous occupation Habits of life Native place Religion Previous... | |
 | Nathaniel Arthur Heywood, Arnold Stuart Massey, Charles Garnett - 1905 - 284 pągines
...annexed order]. The following is a statement of particulars relating to the said Thomas Jones ( 7 ) :— Name of patient with Christian name at length. Sex and age. * Married, single, or widowed. *Rank, profession, or previous occupation (if any). * Religious persuasion. Residence at or immediately... | |
 | Nigeria. Compilations - 1908 - 942 pągines
...STATEMENT. (// any particulars in this statement are not known, this to be stated). Name of patient and Christian name at length. Sex and age. Married, single...Condition of life and previous occupation, if any. The religious persuasion as far as known. Previous place of abode. Whether first attack. Age (if known)... | |
 | Québec (Province) - 1909 - 1104 pągines
...any,) or other circumstances of connection with the patient. Name and sxirname of patient, at full length. Sex and age. Married, single, or widowed....previous occupation (if any). Previous place of abode. Religious persuasion, so far as known. Duration of present attack. Whether first attack. Age (if known)... | |
 | Alexander Wood Renton, Maxwell Alexander Robertson - 1906 - 716 pągines
...Peace for Dated To the Master of the Workhouse of the Statement of Particulars. Name of patient and Christian name at length. Sex and age. Married, single,...Condition of life and previous occupation (if any). Religious persuasion as far as known. Previous place of abode. Whether his first attack. Age (if known)... | |
 | South Australia - 1917 - 458 pągines
...[Signed] , Commanding Officer. STATKMENT. (If any particular* are not known, it it to be so stated. ) Name of patient, with Christian name at length Sex and age Married, single, or widowed Number of children Age of youngest child Previous occupation (if any) Habits of life .... Native place... | |
 | William Henry Butter Stoddart - 1919 - 622 pągines
...omit the particulars marked *.] The following is a Statement of Particulars relating to the saidName of Patient, with Christian Name at length — . —...Sex and Age ------ . *Married, Single, or Widowed ... . — . . *Rank, Profession, or previous occupation (if\ any) J~ *Religious Persuasion ----- —... | |
 | John MacArthur - 1921 - 248 pągines
...Particulars relating to the said : NB— IF ANY PARTICULARS ARE NOT KNOWN, THE FACT TO BE SO STATED. Name of Patient, with Christian name at\ length ....and Age . . . . . . . . Married, Single, or Widowed . . . . Rank, Profession, or previous Occupation) (ifany) / Religious persuasion Residence at, or immediately... | |
 | Federated Malay States - 1921 - 814 pągines
...the particulars in this statement be not known, the fact to be so stated.] Name of patient in full Sex and age Married, single, or widowed Condition of life and previous occupation, if any Religion, as far as known Previous place of abode Whether first attack Age, if known, on first attack... | |
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Married, single, or widowed. Condition of life, and previous occupation (if any). The religious persuasion as far as known. Previous place of abode. Whether first attack. Age (if known) on first attack. When and where previously under care and treatment.... 
