1961-HKRS30-8-52_Part01 — Page 6

7

of

............. request you to receive ás a temporary patient into the above- named hospital in accordance with the provisions of subsection (1) of section 33 of the Mental Health Ordinance, 1960. The particulars of the said

Full name Age

Place of abode

Degree of relationship (if any) to applicant

If not related to the patient-here state-

are as follow-

mnman Sex

(1) Why a relation has not made the application

(2) State your connexion with the person to whom this application

relates

(3) State why you made this application

Dated this

day of

19........

Note: This application must be accompanied by a recommendation signed by a registered medical practitioner who has examined the subject of the application not more than 28 days before this date.

(4) 1 have formed the conclusion stated below on the following grounds-

(a) Facts indicating mental disorder observed by myself

(b) Evidence indicating mental disorder contmunicated to

of

Please state Tests.

me by

(5) I recommend that the above-named person should be received into the above-named Mental Hospital as temporary patient in accordance with the provisions of section 33 of the Mental‍ Health Ordinance, 1960.

Dated this.......................KKAA

19.........

day of

Registered medical practitioner,

Note: The examination must have taken place not more than five days before

the issue of this recommendation.

Plek w Caste

FORM 6.

MENTAL HEALTH ORDINANCE, 1960.

(No. 15 of 1960).

*Della

whichever B inapplicable.

To:

FORM 5.

MENTAL HEALTH ORDINANCE, 1960.

(No. 35 of 1960).

(Section 33)

Recommendation for temporary treatment.

The Medical Superintendent of the Mental Hospital known as ..................

and Situate at

Recommendation for temporary treatment of

I

of

(i) 1 am a registered medical practitioner.

(2) 1

*am am oot

ретвол,

of

declare that-

the medical practitioner usually attending the above-named

(3) I examined the above-named person on the

day of

(Section 35(2)).

Approval by Mental Hospital Visitor of the continued detention of a temporary parlent

To: The Medical Superintendent of the Mental Hospital known as ......nedettes CUPPKRÆFTAMPAKK and situate at

F

a Mental Hospital Visitor, appointed under subsection (1) of section 5 of the Mental Hospital Ordinance, 1960, in respect of the above Mental Hospital certify that I have Loday visited

a temporary patient detained in accordance with the provisions of section 33 of that Ordinance in that hospital, and in accordance with the provisions of subsection (2) of Bection 35 of that Ordinance I certify that it is my opinion that the said patient should continue to be detained as a temporary patient in the above Mental Hospital.

Dated this

day of

Mental Hospital Visitor.

19........