1989 Ed.]
Mental Health Regulations
[CAP. 136
A 15
[Subsidiary]
I apply for the patient to be received into the guardianship of [proposed guardian's name] ..... in accordance with the provisions of section 33 of the Mental Health Ordinance (See Notes 3 & 4).
This application is founded on the attached written opinions in the prescribed form of 2 registered medical practitioners.
I last saw the patient on [date] (See Note 5).
Signed
Date
PART II (See Note 6)
I, [proposed guardian's name, address and identity card number] am willing to act as the guardian of [name of patient] in accordance with section 33 of the Mental Health Ordinance.
* Delete as appropriate.
Signed
Date
Delete this paragraph if applicant is a relative.
A guardianship application should be forwarded to the Director of Social Welfare within 14 days of the patient's last examination by a registered medical practitioner for the purposes of the application.
Notes: 1. Delete (i) or (ii) unless both apply.
2.
3.
4.
5. The applicant must have seen the patient within the previous 14 days.
6. The person named as guardian in a guardianship application may be the Director of Social Welfare or any other person (including the applicant).
Part II to be completed only if proposed guardian is not the Director of Social Welfare.
Page 15
Page 16
A 16
CAP. 136]
[Subsidiary]
致:社會福利署署長