{"text":"GREATER GLASGOW HEALTH BOARD ~ STOBHILL HOSPITAL UNIT \nllIIIIIIIIIIIMIIIIHI WO croermamonconar \nENAMES |UNIT NUMBER \n\u00bb \nCLELLAND \u2018 AGNES \n39 RENNIE RD \nKILSYTH \n61502 \nG65 9PQ 08\/09\/1955 \nFORM 5A \nhereby consent to undergo the operation of _ \/W\u2019(C\u2019Q b\/\u2014\u201d\/\u2019j\u201c? m 9\u2019%6\"\u2018\/ \nthe nature\u2019and effect of which have been explained to me b,y Dr.\/Mr.___ g\/W \n| also consent to such further or alternative operative measures as may be found to be necessary during the course \nof the operatioh and to the administration.of a local or other anaesthetic for any of these purposes, \nNo assurance has been given to me that the operation will be perforrned by a particular surgeon, \nDote _. 777(0[% - .{Sign\u00e9d).A;\/n \/7\\\u2019\\ VM\"M\/ \n| confirm that | have explained to the patient the proposed nature and effect qf this operation, . \nDate m {0(&(16 Signed {Doctor\u2019s Signature) L\/\/ 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