1964_MENTAL_HEALTH_REGULATIONS — Page 10

A 10 CAP. 136]

[Subsidiary]

Mental Health Regulations

[1989 Ed.

FORM 4

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 32(1))

Certificate of medical practitioners for extension of period of detention for observation

To: The Medical Superintendent,

Hospital.

We, [names and addresses of 2 medical practitioners]

registered medical practitioners, *one/both of whom *has/have been approved for the purpose of section 2(2) of the Mental Health Ordinance by the Director of Hospital Services (See Note 1), hereby certify that-

(a) we have examined *separately/together [name of patient, and, if known, identity card

number and address]

who is detained in .....

on

Hospital by virtue of an order made

19 ......... in accordance with the provisions of section 31(1B)

of the Mental Health Ordinance;

(b) we are of the opinion that it is necessary that this patient be detained for a further period of

days for the purpose of observation, investigation and treatment

(See Note 2).

The reasons for my opinion are--

Signed

Registered Medical Practitioner

Date

Page 10