Cuthbert, Henry Pierce

To be filled in by, or on behalf of, Practitioner on
Service.

INTIMATION FORM

Reference Number: 
SMC/3/4/1/3 4:6
Name of Practitioner (Surname): 
Cuthbert
Christian Names in Full: 
Henry Pierce
Address: 

Home Address: North Queensferry; Present Address: Military Hospital, Pembroke

City/Town: 
North Queensferry, Fife
Rank in Army (or Navy): 
Lieut RAMC (Home Service); written by practitioner:] My six months is nearly up -- when I was promised a Captaincy. I have now offered my service until end of war -- if needed.
The above-mentioned Practitioner is on Service as stated
Additional Information: 
[two Intimation forms, one from Practitioner] [Written above signature by proxy signatory:] And the undersigned is carrying on his practice. [Signed by Alexander S. Gordon, MD]

SPECIAL NOTE:

1. Where a Practitioner holds a Commission, but is still at home, this
Intimation Form should be filled in by the Practitioner himself.

2. Where a Practitioner is absent from home on Service, this Intimation Form
should be filled in by some person on his behalf.

 

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.