This HPLHS Prop Document is for entertainment purposes only. Designed and implemented by Andrew Leman. ©2007 by HPLHS, Inc. All rights reserved. Permission is hereby granted for the user to print copies for his/her personal use in role-playing games or personal amusement only. No other permission is granted, and any commer-cial or illegal use of this digital file or the prop you can make from it is ENTIRELY PROHIBITED.

Please do not distribute this file. It is available at www.cthulhulives.org

INSANITY CERTIFICATE NO. 1You’ve paid for your knowledge of the Cthulhu Mythos with your sanity, and you might as well get the acknowledgement you deserve. This handsome certificate is suitable for framing, or can go into the patient’s permanent medical records.

Use Acrobat form fields to enter the name, city and state of residence, date, and certificate number. If necessary, you can specify pica, phobia, paraphilia and other conditions with form fields. You can use the signature form field or delete the default entry and sign the certificate by hand.

Print on elegant off-white resume paper.

Check off all appropriate check boxes by hand.

• Dementia Præcox• Delusions• Paranoia• psychogenic Fugue• Dysphoric Mania• Dissociative Identity Disorder• involutional melancholia• Post-Traumatic Stress Disorder• Dyssomnia• Neurasthenia• morbid whimsicality• Trichotillomania• Amnesia• Catatonia• Depersonalization disorder

• Tillinghast’s Complaint• Xenopharmacophilia• Monomania• Hallucinations • visual • auditory• pica (elaborate) ...................................................................• Obsessive-Compulsive Disorder• Panic disorder• general cacochymy• Separation Anxiety• Hysterical Paralysis• Repetitive Self-Harm Syndrome• abject denial• Sleep Terror disorder

• psychasthenia• intermittent explosive disorder• Multi-infarct Dementia• Epistomophobia• Agateophobia• Nyctophobia• Other Phobia (Specify) .................................................• Megalomania• Paragraphia• Paraphilia (Specify) .........................................................• reactive attachment disorder• Enamorate delirium (chump syndrome)• phrenitis• Selective Mutism• Other (Specify) ....................................................................

Cer�fica�on of Insanity

condition is (Check one):

• Temporary • treatable • incurable

certificant is Harmful to (check all that apply):

• self • others

certificate No.

in testimony whereof:

asylum Director

Know ye, whereas ______________________________________of ______________________________________________

has been examined by the staff of this institution and found to be sorely afflicted with the mental condition(s) noted below;* now, therefore, this

is duly issued this ______ day of _____________, in the year _______.* check all that apply:

form HPLHS IC-08 ©2007 HPLHS, Inc. All rights reserved.