(_k_) _Strike out this clause in case of a private patient whose removal is not proposed._ (_l_) _Insert full postal address._ 53 Vict. c. 5.--Form 9.] (_i_) STATEMENT ACCOMPANYING URGENCY ORDER I certify that it is expedient for the welfare of the said ________ _______________________ (_or_ for the public safety, _as the case may be_) that the said ____________________________________ should be forthwith placed under care and treatment. My reasons for this conclusion are as follows: ____________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. The said _______________________________________________________ appeared to me to be [‡ _____________] in a fit condition of bodily health to be removed to an asylum, hospital, or licensed house (_k_). (‡) Or not to be. 5. I give this certificate having first read the section of the Act of Parliament printed below. =Dated= this ________________ day of _________________________ One thousand nine hundred and ______________ (=Signed=) _____________________________ of (_l_) _____________________________ _Extract from section 317 of the Lunacy Act, 1890._ Any person who makes a wilful misstatement of any material fact in any medical or other certificate, or in any statement or report of bodily or mental condition under this Act, shall be guilty of a misdemeanour. =Orders after Inquisition.=--This constitutes a legal investigation as to whether or not a person is capable of managing his or her own affairs, and whether restraint is necessary. It is conducted before a judge, with a jury if the alleged lunatic demand one, unless the judge is satisfied by personal examination that the lunatic is not mentally competent to understand the demand for a jury. In such a case the medical man is only concerned as a witness. According to circumstances the alleged lunatic may be kept under restraint, or remain at liberty with the control of his or her affairs under a “Committee of Estate”; or, if declared sane, set free and with control of his estate.