1964_MENTAL_HEALTH_REGULATIONS — Page 32

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CAP. 136]

Mental Health Regulations

[1989 Ed.

[Subsidiary]

FORM 10

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 42)

Application for discharge of a patient before recovery

To: The Medical Superintendent,

I, [name and address of *relative/friend]

Hospital.

་་་་་་་་་་

make application in accordance with the provisions of section 42(1) of the Mental Health Ordinance for the discharge of [name of patient, and, if known, identity card number]

from the above-named Mental Hospital.

My relationship or connection with the said patient is that of a

I request that the said patient may be delivered over to me.

I undertake that the said patient will receive proper care and will be prevented from doing injury to *himself/herself or to others.

*I am the person upon whose application the said patient was admitted to a mental hospital.

*I have given notice of this application to

OR

the person upon whose application the said patient was admitted to a mental hospital.

Signed

Date

* Delete as appropriate.

Note: The patient must be discharged within 48 hours unless the Medical Superintendent completes Form 11.

I