Virginia order form for sterilization procedure
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Virginia order form for sterilization procedure
Image 1230 Hospital Form No. 121 VIRGINIA: Before the State Hospital Board At [centered underscore] (Institution) In re: [underscore], Register No.[underscore]Inmate[long bracket]Order for Sexual Sterilization Upon the petition of [underscore] Superintendent of [underscore] and upon consideration of the evidence introduced at the hearing of this matter, the Board finds that the said inmate is [long bracket followed by listing] insane idiotic imbecile feeble-minded epileptic[second long bracket] and by the laws of heredity is the probable potential parent of socially inadequate offsprings likewise afflicted; that the said inmate may be sexually sterilized without detriment to [bracket] his her[bracket] general health, and that the welfare of the inmate and of society will be promoted by such sterilization. Therefore, it appearing that all proper parties have been duly served with proper notice of these proceedings, and have been heard or given an opportunity to be heard, it is ordered that[underscore] (Superintendent)[bracket] perform have performed[end bracket] by Dr. [underscore], on the said inmate the operation of [bracket] vasectomy salpingectomy[end bracket] after not less than thirty (30) days from the date hereof. [underscore, flush right] (Designated Member of Board) Dated [underscore] Note: Make two copies; one for guardian or committee and one for Board. [end]

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