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[[preprinted]] 184 [[/preprinted]]

Sept. 12th

Sir: 

I have the honor to forward herewith an estimate of the number of different blank forms required for use in the Medical Dept. in this District for the 4th Quarter 1867, viz:-

Weekly Reports of Sick &c. | 200 Copies.
Monthly " " " [[dittos for Reports of Sick]] | 100 Copies
Monthly Return of Med. Officers | 24 Copies.
Returns of Property | 20 Sets {Changed to read 10 sets}
Requisitions for Supplies | 100 Copies.
Pay Acct. of Private Physicians | 100 Copies
Monthly Report of Attendants | 50 Copies.
Contracts with Private Physicians | 50 Copies.
Oaths | 50 Copies.

Very respectfully
Your obt. servant
[[signature]] Wm. F. Smith [[/signature]]
Capt. and Asst. Surg. U.S.A.
Surgeon-in-Chief.

Chief Medical Officer
Bureau of R.F. & A.L.
Washington D.C.