1964_MENTAL_HEALTH_REGULATIONS — Page 6

CAP. 136

Mental Health Regulations

[1989 Ed.

[Subsidiary]

FORM 2

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 31(1A))

Certificate of a medical practitioner in support of application for removal of a patient to a mental hospital for the purpose of detention and observation

I, [name and address of medical practitioner]

a registered medical practitioner, am of the opinion that [name of patient, and, if known, identity card number and address]

should be removed to Hospital for the purpose of detention and observation in pursuance of an order made under section 31(1B) of the Mental Health Ordinance, I last examined this patient on [date]

I am of the opinion that this patient-

(See Note 1).

(a) is suffering from mental disorder of a nature or degree which warrants *his/her detention in a mental hospital for *observation/observation followed by treatment for at least a limited period;

AND

(b) ought to be so detained (See Note 2)-

(i) in the interests of *his/her own health or safety; and (ii) with a view to the protection of other persons.

The grounds for the opinion I express in paragraph (a) above are as follows-

The reasons for the opinion I express in paragraph (b) above are as follows-

The patient *has/has not requested to see the District Judge or Magistrate.

Signed

Registered Medical Practitioner

Date

* Delete as appropriate.

Notes: 1. The medical practitioner who gives this certificate must have examined the patient within the previous 7 days.

2. Delete (i) or (ii) unless both apply.