896
THE NEW ZEALAND GAZETTE.
[No. 40

8. Inmates—
   Number of inmates—
   On 31st March, 19
   Admitted during year

Total number of inmates

Number of inmates—
Discharged during year
Died during year
In institution on 31st March, 19

Total number of inmates

9. Sex—Male : Female : Total :
10. Inmates—Collective days’ stay :
11. Inmates—Individual average days’ stay :
12. Inmates—Weekly fee charged for maintenance :
13. Localities, broadly, from which patients came :

TABLE III.
………Hospital or Charitable Institution.
MAINTENANCE EXPENDITURE FOR YEAR ENDED 31ST MARCH, 19 .

I. Provisions
II. Surgery and dispensary
III. Domestic and establishment
IV. Salaries and wages
V. (1.) Reductions in patients’ fees allowed by the Board ..£
(2.) Amount written off as irrecoverable .. .. ..£

VI. Miscellaneous expenditure

Total .. .. .. £

TABLE IV.
………Hospital and Charitable Aid Board.
………Institution.
GROUNDS ACCOUNT.

1. Area of ornamental grounds :
   Area of kitchen garden or farm land :
   Total area :

2. Average number of hands employed (other than inmates) :

3. Average number of inmates employed per diem throughout the year :

4. Income—
   (a.) Sale of produce
   (b.) Value consumed in institution
   (c.) Value supplied to other institutions of Board
   (d.) Other receipts
   (e.) Balance (if any) to Income and Expenditure Account (Domestic and Establishment)

5. Expenditure—
   (a.) Wages to gardeners and farm hands (including cartage, &c.)
   (b.) Gratuities to inmates
   (c.) Manure, seed, implements, &c.
   (d.) Other expenditure
   (e.) Balance (if any) to Income and Expenditure Account (Miscellaneous Income)

TABLE V.
………Hospital and Charitable Aid Board.
DISTRICT NURSES UNDER CONTROL OF BOARD DURING YEAR ENDING 31ST MARCH, 19 .

1. Name of nurse :

2. Where stationed :

3. Describe roughly district served by nurse :

4. Number of persons receiving professional attention by nurse during year :

5. How many of these were maternity cases :

6. Income—
   (a.) Fees receivable
   (b.) Voluntary contributions
   (c.) Sums guaranteed by settlers’ associations
   (d.) Miscellaneous income
   (e.) Balance (if any) to Income and Expenditure Account (District Nursing)

7. Expenditure—
   (f.) Amount payable by Board in nurse’s salary during year
   (g.) Amount payable in travelling-expenses
   (h.) Other expenditure
   (i.) Balance (if any) to Income and Expenditure Account (Miscellaneous Income)

£ s. d.

£

TABLE VI.
………Hospital and Charitable Aid Board.
PUBLIC HEALTH ACCOUNT.

Income.
£ s. d.

1. Special contributions to Inspectors’ salaries

2. Other income, giving principal items— £ s. d.

3. Balance to Income and Expenditure Account (Public Health)

£

Expenditure.
£ s. d.

1. Salaries of Public Health Inspectors
2. Travelling-expenses of Public Health Inspectors
3. Other expenditure—Principal items— £ s. d.

£

TABLE VII.
………Hospital and Charitable Aid Board.
MEDICAL ASSOCIATIONS AIDED BY BOARD DURING YEAR ENDED 31ST MARCH, 19 .

TABLE VIII.
STATEMENT AS TO THE APPORTIONMENT OF EXPENDITURE AMONG CONTRIBUTORY LOCAL AUTHORITIES, AND THE PAYMENT OF SUBSIDY THEREON.

1. Capital Expenditure.
   £ s. d.
   Estimated capital expenditure for the year ending 31st March, 19
   Less estimated receipts on account of capital expenditure

Net estimated expenditure

Amount of capital expenditure apportioned amongst contributory local authorities
Amount of subsidy which will be claimed at £1 for £1

Total

2. Other Expenditure.
   Estimated expenditure other than capital expenditure for the year ended 31st March, 19
   Less estimated receipts on account of other expenditure

Net estimated other expenditure

Amount apportioned among contributory local authorities
Amount of subsidy which will be claimed at in £1

Total

………Secretary to the Board.