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[接上页] (Business Registration Certificate No.) Particulars of the names and addresses of all persons who are professionally qualified directors, other directors or managers of the above company in respect of the business of physiotherapy carried on by it at ............................................................................................. ............................................................................................................................................. under the name of ................................................................................................................. Name in full Position Certificate of Registration No. and Date of Registration where Directors are registered Part registered in Residential address and of persons who practise physiotherapy in connection with the business of the said company in the above. Name in full Residential address Occupation Qualifications Certificate of Registration No. and Date of Registration Part registered in Duties performed Dated this ................... day of ................. 19 ......... (Signature) ........................................... (State whether director or manager or secretary) FORM 4 [section 23(2)] SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359) PHYSIOTHERAPISTS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION Notice of Inquiry [Date] Sir/Madam, On behalf of the Physiotherapists Board notice is hereby given to you that, in consequence of a complaint made against you to the Board/information received by the Board, an inquiry is to be held into the following charge(s) against you- (If the allegation relates to conviction) That you were on the ............... day of .................. 19 ....... at ............................................................................................................................. ........................................................................................................................ (specify court recording the conviction) convicted of ......................................................................... (set out particulars of the conviction in sufficient detail to identify the case). or (If the charge relates to conduct) That you ..................................................................... ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. (set out briefly the facts alleged); and that in relation to the facts alleged you have been guilty of unprofessional conduct. or (If the allegation relates to obtaining registration by fraud or misrepresentation) That you ............................................................................................................................................. ............................................................................................................................................. ................................................................................................................................. (set out briefly the facts alleged); and that in relation to the facts alleged you obtained registration by fraud or misrepresentation. or (If the allegation is that the registered physiotherapist was not qualified, at the time of his registration, to be registered) That you .................................................................................... ............................................................................................................................................. ............................................................................................................................................. ................................................................................................................................. (set out briefly the facts alleged); and that in relation to the facts alleged you were not at the time of your registration qualified to be registered. or (If the allegation is that the registered physiotherapist has not complied with or is in breach of any condition of his registration or has failed to comply with the Ordinance) That you ............ ............................................................................................................................................. ............................................................................................................................................. ................................................................................................................................. (set out briefly the facts alleged). |