477966-1938-Asylums-Ord--1936-Order-under-section-4-of-the — Page 1

914

THE HONG KONG GOVERNMENT GAZETTE, DECEMBER 16, 1938.

EXECUTIVE COUNCIL.

No. 966.

Hong Kong.

ORDINANCE No. 22 of 1936. (ASYLUMS).

By virtue and in exercise of the powers conferred by section 4 of the Asylums Ordinance, 1936, the Governor in Council prescribes the following forms :-

G.

HONG KONG.

FORM No. 1.

R.

Application for an order for the removal to a mental hospital for the purpose of detention and observation of a person believed to be of unsound mind.

I

Asylums Ordinance, 1936, s. 7.

of

Strike out

the inappro-

priate

have reason to believe that

of

is a person of unsound mind.

The reasons for my belief are as follows:-

(a) (Result of personal observation). (b) (Facts communicated to me by others).

paragraph.

of

who is said to be

of the person in question, has been communicated with, with the following result

or

No relative of the person in question can be found in the Colony.

I therefore apply under section 7 of the Asylums Ordinance, 1936,

for a written order authorizing the said

to be conveyed to the Government Mental Hospital and to be detained there under observation for a period not exceeding seven days.

Dated the ............ day of

19........

+

Signature of applicant.