Cap. 31 Art. 12

Signature of the Medical Practitioner ....................................

Date ............................................................................... Name in Block Letters .................................................... Address .......................................................................... TO THE POLICE OFFICER IN CHARGE OF THE ACTS OF DEATH IN ................................................................................. *NOTES: The certifier should enter under -I. (a) The disease or injury which initiated the train of morbid events leading to death, i.e. the disease, injury or complication which was the direct cause of death. This does not mean the mode of dying e.g. heart failure, asthenia, etc.

(b) The condition, if any, considered to have been antecedent to the direct cause, both in respect of time and of etiological or pathological relationship. A condition can be entered as antecedent even though a long interval of time has elapsed since its onset or since the occurrence of symptoms of it. Any other condition which is considered to be antecedent to in the same

(c) (b) sense as described above. If it is thought that there has not been any antecedent condition as defined above, lines I and I should be left blank.

(b) (c) On no account must the starting point of the sequence of disease be entered in Part II because of lack of space for it in Part I. II. Any other conditions which, though not in the causal sequence in Part I, appear to have contributed something to the fatal outcome.

THIRD SCHEDULE

(Article 40a)

L O P D IST F SYCHOTROPIC RUGS