|Date of Injury:|
|D.O.B/Age when admitted:|
|Cause of Incident:|
Sporting Accident. Boxing. Received blow from elbow.
|Transferred to QVH:|
|No. of Operations at East Grinstead:|
This is to certify that the patient mentioned below and whose description is stated hereon is the authorised holder of this Identity card.
|Age at Death:|
|Dr Rank:||Dr Unit:|