Sch. Sch. 5 6 *(Strike out whichever does not apply) __________________ SCHEDULE 6 Regulation 48 Health Services ( and Day Procedure Centres) Regulations 2002 DOCUMENT THING Name of private hospital or day procedure centre: Address of private hospital or day procedure centre: I, , being an authorised officer of the Department, am (print full name) seizing under section 147 of the the document or Health Services Act 1988 thing listed below. The seized document or thing will be returned to the place of seizure within 48 hours from the time of seizure. DOCUMENT OR THING SEIZED 1. 2. 3. Signed: Date: Time: (Authorised Officer) Signed: Date: Time: (Proprietor/staff member) OR RETURNED Signed: Date: Time: (Authorised Officer) Signed: Date: Time: (Proprietor/staff member)
*(Strike out whichever does not apply) Sch. 5 __________________ SCHEDULE 6 Sch. 6 Regulation 48 Health Services ( and Day Procedure Centres) Regulations 2002 Name of private hospital or day procedure centre: Address of private hospital or day procedure centre: I, , being an authorised officer of the Department, am (print full name) seizing under section 147 of the Health Services Act 1988 the document or thing listed below. The seized document or thing will be returned to the place of seizure within 48 hours from the time of seizure. DOCUMENT OR THING SEIZED 1. 2. 3. Signed: Date: Time: (Authorised Officer) Signed: Date: Time: (Proprietor/staff member) DOCUMENT OR THING RETURNED Signed: Date: Time: (Authorised Officer) Signed: Date: Time: (Proprietor/staff member)
02-79sr007.docx