Large, Stanley Dermot

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

INTIMATION FORM

Reference Number: 
SMC/3/4/1/8 1:3
Name of Practitioner (Surname): 
Large
Christian Names in Full: 
Stanley Dermot
Address: 
100th Field Ambulance BEF France
Rank in Army (or Navy): 
Captain RAMC
The above-mentioned Practitioner is on Service as stated
Additional Information: 
Signed by W R Large, 65 Morton St, Joppa
Present Work: 
Has been in RAMC for last two years, and at the front since August 1914

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.