|
[接上页] 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. FORM 3 MENTAL HEALTH ORDINANCE (Chapter 136) (Section 31(1B)) ORDER BY A DISTRICT JUDGE OR MAGISTRATE AUTHORIZING THE REMOVAL OF A PATIENT TO A MENTAL HOSPITAL FOR THE PURPOSE OF DETENTION AND OBSERVATION I, [name and address]................................................................................................ ...................................................................................................................................., a *District Judge/magistrate having received an application made under section 31(1) of the Mental Health Ordinance from [name and address of applicant] ......................................... ............................................................................................................................... dated ................................. and a medical certificate in support from [name and address of registered medical practitioner] ......................................................................................... ........................................................................................................................................ ........................................................................................................................................ ............................................................................................................................... dated .......................................................................... in pursuance of section 31(1B) of the Mental Health Ordinance hereby authorize the removal of [name of patient, and, if known, identity card number and address] ..................................................................................... ........................................................................................................................................ ........................................................................................................................................ to ........................................................... Hospital for the purpose of detention and observation for a period of not exceeding 7 days from and including the date of this order. Signed ...............................................*District Judge/Magistrate Date .................................................. * Delete as appropriate. 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 Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113) (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 .............................................. Hospital by virtue of an order made on ......................... 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 ........................................................ The reasons for my opinion are- Signed ..................................................... Registered Medical Practitioner Date ........................................................ Countersigned in accordance with the provisions of section 32(2) of the Mental Health Ordinance. Signed ...........................................District Judge Date ............................................... * Delete as appropriate. Notes: 1. At least one of the registered medical practitioners who signs this certificate must be approved for the purpose of section 2(2) of the Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap. 113). |