CAP. 136]
Mental Hospitals.
G.N.A. 79/51.
G.
HONG KONG.
FORM 6.
R.
Application for reception as a voluntary patient.
Mental Hospitals Ordinance, s. 9 (Chapter 136 of the Revised Edition.)
I hereby apply to be admitted to the mental hospital as a voluntary patient.
I undertake, as from the date of my admission--
(a) to pay all fees charged by the mental hospital for maintenance and treatment;
(b) to conform to all the regulations of the mental hospital;
(c) to give the M.O. i/c 72 hours' notice of my intention to leave the mental hospital;
(d) forthwith to leave the mental hospital when so required by the M.O. i/c;
(e) to make no claim against the mental hospital in respect of loss or damage to any property brought into it (including private clothing).
Dated the ......... day of ......... 19......
To the M.O. i/c of the Hospital, Hong Kong.
Signed ....................................
Witness ....................................
CAP. 136]
Mental Hospitals.
G.N.A. 79/51.
G.
HONG KONG.
FORM 6.
R.
Application for reception as a voluntary patient.
Mental Hospitals Ordinance, s. 9 (Chapter 136 of the Revised Edition.)
of
I
hereby apply to be admitted to the mental hospital as a voluntary
patient.
I undertake, as from the date of my admission--
(a) to pay all fees charged by the mental hospital for main-
tenance and treatment;
(b) to conform to all the regulations of the mental hospital;
(c) to give the M.O. i/c 72 hours' notice of my intention to
leave the mental hospital;
(d) forthwith to leave the mental hospital when sɔ required
by the M.O. i/c;
(e) to make no claim against the mental hospital in respect of loss or damage to any property brought into it (including private clothing).
Dated the .........day of
To the M.O. i/c of the Hospital, Hong Kong.
1
..་་..--
52
Signed
Witness
19......
.Mental
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