1964_VENEREAL_DISEASE_ORDINANCE — Page 6

1989 Ed.]

Venereal Disease

[CAP. 275

5

To:

FORM 2

VENEREAL DISEASE ORDINANCE

(Chapter 275)

Examination Notice

(s. 4]

According to information received in pursuance of section 3 of the Venereal Disease Ordinance (Cap. 275), I, the Deputy Director of Health have reason to believe that you may require treatment in respect of venereal disease.

I therefore, in pursuance of section 4 of the said Ordinance, give you notice that you are required to attend for, and submit to medical examination within

days of the 19, by a medical practitioner. Medical examination under this heading will be made free of charge if undergone in a government social hygiene clinic.

day of

*

FORM 3

VENEREAL DISEASE ORDINANCE (Chapter 275) Clearance Certificate

[s. 5]

To: Deputy Director of Health,

I

Department of Health.

(medical practitioner) hereby certify that I have this day examined (insert name of contact)

and I am of opinion that:

* (a) the said

*

venereal disease in a communicable form; (b) the said....

* Strike out whichever is not applicable.

is not, at the date hereof, suffering from a

does not require any further treatment.

Dated this

day of

19

,

Note:

(Signed)

Medical Practitioner

The contact may be informed by the medical practitioner of the contents of the certificate but it should not be handed to the

contact.

FORM 4

VENEREAL DISEASE ORDINANCE (Chapter 275)

Treatment Notice

[s. 5]

To:

In pursuance of section 5 of the Venereal Disease Ordinance (Cap. 275), I hereby give you notice to attend for and submit to further examination and treatment of

in accordance with direction given by

and to continue to do so, until a clearance certificate in respect of yourself has been issued.

Dated this

day of

19

"

(Signed)

Medical Practitioner

(Schedule amended L.N. 76 of 1989)