A 14
CAP. 136]
Mental Health Regulations
[1989 Ed.
[Subsidiary]
FORM 5
MENTAL HEALTH ORDINANCE
(Chapter 136)
(Section 35A(1)).
Application for admission into guardianship under section 33(1)
To: The Director of Social Welfare.
PART I
I, [name and address of applicant] .
., have reason to believe that--
(a) [name of patient, and, if known, identity card number and address]
is suffering from mental disorder of a nature or degree which warrants *his/her reception into guardianship under section 33(1) of the Mental Health Ordinance;
AND
(b) it is necessary that the patient should be so received (See Note 1)-
(i) in the interests of the welfare of the patient; and
(ii) for the protection of other persons.
The reasons for my belief are-
*The patient is aged
OR
[if the patient's age is not known] *I believe that the patient has attained the age of 18 years.
I am *the [state relationship]
practitioner/a public officer in the Social Welfare Department.
of the patient/a registered medical
I have consulted a relative of the patient, namely *his/her [state relationship and name and
address of relative]
about this application (See Note 2).
OR
I have been unable to locate any relative of the patient in Hong Kong (See Note 2).
1