Immunisation (Forms) Regulations, 1982

L.N. 28 of 1982

PREVENTION OF D!SEASE ORDINANCE (CAP. 59)

Immunisation (Forms) Regulations, 1982

IN exercise ef the pewersconferred by sectien 61 ef the Preventien

ef Disease Ordinance. the Minister ef Health has made the fellewing

regulatiens : -

l. These regulatiens may be cited as the Immunisatien (Ferms)

Regulatiens, 1982.

Dawn ir-regolamenti jistgħu jissejħu r-Regolamenti ta' 1-1982

dwar it-Tilqim (Formuli).

Regulation 2

Form No. 1

ċERTIFIKAT TA' TILQIM

CERTIFICATE OF V ACCINATION

Jiena, hawn taħt iffirmat, niċċertifika li .............. .... ........ .. .. , ... . ... ..... .. .... .... .

l, the undersigned, hereby certify that

iben/bint .............. ... ... .. ........ imwieled/a .... .. .. ... .... ............ fi ......... " .......... .

the sonjdaughter of

born at

on

u li joqgħod/toqgħod ...... .. .... ....... .. ............... ...... ....... ........ ..... .. .... .... ..... . .. .

and residing at

ġie/t imlaqqam/a minni kontra d-Difterite, Tetnu u Poljomijelite kif ġej

has been immunized by me against Diphtheria, Tetanus, and Poliomyelitis as follows

DOŻA

DATA

XORTA TA' TILQJ M

lSEM IT-TAB1H

NAME OF MEDICAL

TYPE OF VACCINE

DATE

DOSE

PRACTlTJONER

L-ewwel doża

First dose

!t-tieni doża

Second dose

!t-tielet doża

Third dose

Dożi Booster

Booster doses

Firma tat-Tabib

Signature of M edical Practitioner

Isem u Indirizz (ITTRI KAPITALI) ... ... ... ...... ................ .. ... ....................... .

Name and Address (IN BLOCK LETTERS)

~

Data

Date

B

Form No. 2

ċERTIFIKAT LI

TILQIMA TĦALLIET GĦAL DARB'OĦRA

CERTIF/CATE OF POSTPONEMENT

Jiena, hawn taħt iffirmat, b'dan niċċertifika li fil-fehma tiegħi

I, the undersigned, hereby certify that I am of the opinion that

iben/bint ..... ......... ........ ....... .... irnwieledla .. ... . ............ .... .. fi ........... .. .... .

the son/daughter of

born at

on

u li joqgħod/toqgħod ..... ... ... ...... ..... .. .... ........... .................... .... mhux fi stat li

and residing at

is not at present

jitlaqqarn/titlaqqarn kontra d-Difterite, Tetnu u Poljornijelite. u għalhekk qed in ħalli

in a fit and proper state to be immunized against Diphtheria, Tetanus .and Poliomyelitis,

t-tilqirna għal darb'oħra. It-tarbija għandha terġa' tinġieb għat-tilqirna fi .. ...... ....... .. .

and i do hereby postpone the immunizat;on. Child is to be brought again for immuniza-

tion on

Firma tat-Tabib

Signature of Medical Practitioner

Isem u Indirizz (ITTRI KAPIT ALl) ... .. ... . ...... .. ..... ...... ... ... .... ...... ... . ... .. ... ..... . .

Name and Address (IN BLOCK LETTERS)

Data ......... . .. . .......... .............. ....... .

Date

Meta t-tarbija tkun għalqet is-sena, dan iċ-ċertifikat għandu jiġi appro-

NOTA

NOTE

When child is over one year, fhis certificate must be approved by a Me-

vat minn UffiċJal Mediku tas-Saħħa.

dical Officer of Health.

Form No. 3

AVViz LILL-ĠENITURI

NOTICE TO PARENTS

Jiena, hawn taħt iffirmat, navżak li għandek tlaqqam il-tarbija 11) .... ..

...

0. ...

.

.

0"

I, the undersigned, hereby give you nOTice to have the child (I)

li t-twelid tagħha issa huwa reġistrat, kontra d-Difterite, Tetnu u

o ••

00.00

••

00.0

•

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0. whose birth is now registered, immuni.z.ed against Diphtheria, Te-

Poljomijelite malli tagħlaq it-tliet xhur, skond id-disposizzjonijiet ta' l-Ordinanza dwar

tanius and Poliomyelitis on reaching the age of tnl'ee month.s in accordance with the pro-

it-Tharis mill-Mard (Kap. 59) u jekk tonqos milli tagħmel hekk tista' teħel il-penalitajiet

visions of the Prevention of Disease Ordinance (Capo 59) and in default of your doing

stabbiliti bil-liġi.

so you will be liable to the penaltie.s laid down by the law.

Illum

ta'

00000

0000000

••

.00.

••

••

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••

Dated this

of

Iffirmat

Signed

Isem (ITTRI KAPIT ALl)

00000.0.0000000

0.0.0

00.000.

•

•

•

•

•

Name and Surname (BLOCK LETTERS)

Uffiċjal Anzjan tal-Pulizija Inkarigat mid-Distrett ta'

•

•

0000.

0.0

00000

•

•

•

Senior Police Officer in charge of

District.

Niżżel l-Isem

(1)

Insert Name

(1)

B

ORDINANZA DWAR IT-TĦARIS MILL-MARD

Tifsir

Il-ġenituri, jew kull persuna oħra Li jkollha taħt il-kura tagħha tarbija ta' iżjed

minn tliet xhur, u li mhix imlaqqma kif għandha tkun kontra d-Difterite. it-Tetnu u

l-Poljomijelite għandhom jieħdu din it-tarbija f'Ċentru tat-Tilqim fil-Furjana jew ir-

Rabat, Għawdex, biex tiġi mlaqqma u għandhom jerġgħu jieħdu t-tarbija għal aktar

dożi skond kif jiġu miktuba mill-Uffiċjal inkariga.t minn dan iċ-Ċentru.

Jekk it-tarbija ma tkunx fi stat li tista' titlaqqam il-ġ,enituri jew persuna oħra

għandhom jieħdu ċertifikat mingħand it-tabib taċ-ċentru tat-Tilqim fejn hemm imfisser

din .iċ-ċirkostanza. u għandhom jerġgħu jieħdu t-tarbija fid-data li tiġi indikata fuq

l-istess ċerti:fjikat Meta t-tarbija tk un għalqet sena dan iċ-ċertifikat għandu jiġi kkonfer-

mat mill-Uffiċjal Mediku tas-Saħħa.

Il-missier jew l-omm jew kull persuna oħra bħalma hu msemmi hawn fuq jistgħu

jieħdu t-tarbija biex titlaqqam għand tabib privat. F'dawn il-każi t-tabib privat għandu

jagħti ċertifikat tat-tilqirna / tħol1ija għal darb'oħra, skond il-liġi.

PREVENTION OF nlSEASE ORDINANCE

Explanatory Statement

Parents or other persons having the custody of a child who is more than 3 rnonths

old and who is not ful1y protected by irnmunisation against Diphtheria, Tetanus and

Poliomyelitis shall take suah child to an Immunisation Centre in Floriana of Victoria,

Gozo, to be properly immunised and shall take such child again for further doses as

directed by the Officer in charge of such Centre.

If the child is not in a proper and fit state to be immunised, parents or other

persons should procure from the Medical Officer in charge of the Centre a Certificate to

that effect, and shall take the child again to the Centre as directed in the said Certif1-

cate. When the child attains the age of one year such certificate is valid only if

approved by a Medical Officer of Health.

It shall be lawful for any parent or other person as aforesaid to take the child to be

immunised by a private practitioner. In such cases the private practitioner shall forward

a certificate of vaccination/postponement according to law.

Ippubblikat mit-Taqsima tat-Tagħrif -

Publishecl by the Information Division -

Kastilja

Kastilja -

Mitbugħ

Printecl at the Government Printing Press

fl:Istamperija tal 'Gvern -

(1) The c-ertificate of immunisation required under sectien 54

of the Preventien ef Disease Ordinance shan be drawn up in accerdance

with Ferm Ne. 1 of the Schedule te these regulatiens.

(2) The certificate ef pest;ponement ef immunisation

required under sectien 52 of the said Ordinanc-e shall be drawn up in

accerdance with Form N e. 2 ef the Schedule te these regulatiens.

(3) The notice required te be given by the Police under

section 56 ef the said Ordinance shall be drawn up in accordance with

Form Ne. 3 of the Sohedule te these regulatiens.

B