1964_MENTAL_HEALTH_REGULATIONS — Page 18

A 18 CAP. 136]

[Subsidiary]

Mental Health Regulations

[1989 Ed.

FORM 6

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 33(3))

Certificate of medical practitioners in support

of application for guardianship

We, [names and addresses of two 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), are

of the opinion that [name of patient, and, if known, identity card number and address]

should be received into guardianship in pursuance of

an application made under section 33(1) of the Mental Health Ordinance.

I, [name of first practitioner]

last examined the patient

on

In my opinion this patient is suffering from mental disorder of a nature or degree which warrants reception into guardianship under the Mental Health Ordinance. This opinion is founded on the following-

[Give clinical description of the patient's mental condition]

I am of the opinion that it is necessary (See Note 2)—

(a) in the interests of the welfare of the patient; and

(b) for the protection of other persons,

that the patient should be so received for the following reasons—

[Reasons should state why the patient cannot appropriately be cared for without powers of guardianship]