Cap. 343A 《診療所(表格)規例》Medical Clinics (Forms) Regulations

Schedule

Form 1

[reg. 2]

Register of Clinics

1	2	3	4		5	6		7
Certificate No.	Date of Issue	Date of Expiry	Registered Name of Clinic		Address of Clinic	Name of Person Registered in respect of Clinic		Address of Person specified in column 6
			in English	in Chinese		in English	in Chinese

8	9	10
Reference to Conditions of Registration	Whether exempted from sections 6 and 7	Reference to Conditions of Exemption from sections 6 and 7

__________

Form 2

[reg. 3]

Certificate of Registration of clinic not exempted from section 7 of the OrdinanceM C O
(Chapter 343)C R N . .

(Valid until 19 )

T that the undermentioned clinic is registered in the register of clinics under the Medical Clinics Ordinance—
Particulars of clinic—
Name (In English)
(In Chinese)
Address
Particulars of person registered in respect of above clinic—
Name (In English)
(In Chinese)
Address
Particulars of registered medical practitioner appointed pursuant to section 7 of the Medical Clinics Ordinance—
Name (In English)
(In Chinese)
Address
Note:	Registration of the above-named person in respect of the above-named clinic is subject to the conditions specified
			(here indicate where conditions are
	specified, e.g. overleaf, or—in the annexure hereto marked			,
	or as the case may be).
	Dated this . day of ., 19.
		Registrar of Clinics

(L.N. 47 of 1967)

__________

Form 3

[reg. 3]

Certificate of Registration of clinic exempted from section 7 of the OrdinanceM C O
(Chapter 343)C R E N . .

(Valid until 19 )

T that the undermentioned clinic is registered in the register of clinics under the Medical Clinics Ordinance, but is exempted from the provisions of section 7 of the aforesaid Ordinance—
Particulars of clinic—
Name (In English)
(In Chinese)
Address
Particulars of person registered in respect of above clinic—
Name (In English)
(In Chinese)
Address
Note:	Registration of the above-named person in respect of the above-named clinic and the grant of the exemption hereby certified is subject to the conditions respectively specified
	(here indicate where conditions are specified, e.g. overleaf, or in the annexure hereto marked
		, or as the case may be).
	Dated this . day of ., 19.
		Registrar of Clinics

(L.N. 47 of 1967)