Mar. 18.] THE NEW ZEALAND GAZETTE. 895

........Hospital and Charitable Aid Board.

BALANCE-SHEET AT 31ST MARCH, 19

Liabilities.
£ s. d.

1. Patients’ fees, &c., received in advance.. ..
2. Contractors’ deposits .. .. ..
3. Sundry creditors .. .. ..
4. Loans .. .. ..
5. Unexpended income balances of special funds ..
6. Capital accounts— £ s. d.
   (a.) Balance on 31st March, 19 ..
   Less excess of income over
   expenditure (if any) for year
   ended on that date, trans-
   ferred to Income and Ex-
   penditure Account ..
   (b.) Endowments for special purposes ..
   (c.) Funds for land, buildings, and equipment
7. Income and Expenditure Account .. ..
   £

Assets.
£ s. d.

1. Cash in bank and on hand—
   (a.) Amount for general
   maintenance ex-
   penditure ..
   (b.) On account of funds
   for capital ex-
   penditure
   (c.) On account of unex-
   pended balances
   of income for
   funds

Total cash .. .. ..

2. Expenses paid in respect of ensuing year ..
3. Sundry debtors .. .. ..
4. Stores in hand .. .. ..
5. Investments on Capital Accounts— £ s. d.
   (a.) For special purposes .. ..
   (b.) For land, building, and equip-
   ment
   (c.) For general purposes ..

Total .. .. ..

6. Land, buildings, and equipment .. ..

Details as follows:—
........Institution—
Land ..
Buildings ..
Equipment ..

........Institution—
Land ..
Buildings ..
Equipment ..

........Institution—
Land ..
Buildings ..
Equipment ..

Total ..

7. Income and Expenditure Account .. .. £

SECOND SCHEDULE.

TABLE I.
........Hospital and Charitable Aid Board.
........Hospital.

STATISTICAL.

1. Name of Chairman of Hospital Committee :
2. Usual date of Hospital Committee meeting :
3. Medical staff—
   (a.) Honorary :
   (b.) Stipendiary :
   (1.) Resident at the hospital (i.e., with perma-
   nent quarters and board at institution) :
   (2.) Not resident at the hospital :
4. Dispensers—Number :
5. Nursing staff—
   Name of Matron :
   Number of registered nurses :
   Number of probationers :
6. Domestic staff—
   Cooks :
   Housemaids :
   Wardsmaids :
   Wardsmen :
   Laundresses :
   Porters :
   Gardeners :
   Engineers and stokers :
   Others, stating post held :
7. Number of beds available—For males : For fe-
   males : Children’s cots : Isolation and
   infectious : Total :
8. Average number of patients per diem :
9. Average number of patients to each of nursing staff, in-
   clusive of probationers :
10. Average number of staff per diem receiving board :
11. In-patients—
    Number of patients—
    On 31st March, 19 .. .. ..
    Admitted during year .. .. ..
    Total under treatment .. .. —

Number of patients—
Discharged during year .. .. ..
Died during year in hospital on 31st March, 19
Total under treatment .. .. —

12. Sex—Male : Female : Total :
13. In-patients—Collective days’ stay :
14. In-patients—Individual average days’ stay :
15. In-patients—Weekly fee charged for maintenance of
    adults :
16. Localities, broadly, from which patients came :
17. Number of out-patients treated during year :
    Number of attendances of such out-patients :

TABLE II.
........Hospital and Charitable Aid Board.
........Charitable Institution.

STATISTICAL.

1. Name of Chairman of Institutional Committee :
2. Usual date of Institutional Committee meeting :
3. Medical staff—
   (a.) Honorary :
   (b.) Stipendiary :
   Is he resident ?
   Does he give whole or part time ?
4. Name of Master :
   Name of Matron :
   Is she a registered nurse ?
   Nurses other than Matron :
   Cooks :
   Housemaids :
   Laundresses :
   Porters :
   Gardeners :
   Engineers and stokers :
   Others, stating post held :
5. Number of beds available—For males : For
   females : Children’s cots : Isolation and
   infectious : Total :
6. Average number of inmates per diem :
7. Average number of staff receiving board per diem :