1989 Ed.]
Mental Health Regulations
[CAP. 136
A 3
SCHEDULE
[Subsidiary]
[reg. 2]
FORM 1
MENTAL HEALTH ORDINANCE
(Chapter 136)
(Section 35A(1))
Application under section 31(1) for removal of a patient to a mental hospital for the purpose of detention and observation
I, [name and address of applicant]
have reason to believe that [name of patient, and, if known, identity card number and address]
(a) is suffering from mental disorder of a nature or degree which warrants *his/her detention in a mental hospital for *observation/observation followed by medical treatment for at least a limited period;
AND
(b) ought to be so detained (See Note 1)-
(i) in the interests of *his/her own health or safety; and
(ii) with a view to the protection of other persons.
The reasons for my belief are-
I am *the [state relationship] of the patient/a registered medical practitioner/a public officer in the Social Welfare Department.
I have informed a relative of the patient, namely *his/her [state relationship and name and address of relative]
OR
I have been unable to locate any relative of the patient in Hong Kong and it is impracticable to delay the making of an order until a relative can be found (See Note 2).
I apply for an order in accordance with the provisions of section 31(1B) of the Mental Health Ordinance authorizing the removal of the patient to a mental hospital for the purpose of detention and observation.
This application is founded on the attached written opinion of a registered medical practitioner in the prescribed form.
I last saw the patient on [date] (See Note 3).
* Delete as appropriate.
Notes:
Signed
Date
1. Delete (i) or (ii) unless both apply.
2.
3. Delete this paragraph if applicant is a relative.
The applicant must have seen the patient within the previous 14 days.