Hong Kong Regulations

PHYSIOTHERAPISTS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION - SCHEDULE 2

FORMS

(Past version on 01/07/1999).
(Past version on 30/06/1997).

[sections 7, 9, 14, 23 & 42]

FORM 1 [section 7(1)]

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

PHYSIOTHERAPISTS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION

Application for Registration/Provisional Registration as a Physiotherapist

I ...........................................................................
.................................................... of

(name in both English and Chinese)
...........................................................................
......................................................... being

(correspondence or home address) qualified for registration as a
physiotherapist under section  12 (1)*(a)/(b)/(c)/section 15 of the
Supplementary Medical Professions  Ordinance apply for
*registration/provisional registration as a physiotherapist and request that
my name be placed on Part *Ia/Ib/II of the Register.

2. I hold the following qualifications (please state qualifications obtained
in chronological order):

Qualification Issuing Authority Date Issued

3. I have the following professional experience (please state professional
experience obtained in chronological order):

Period

Post Title
Name of Organization/Company From To

4. My business address(es) *is/are as follows: (English)
...........................................................................
....................................................
...........................................................................
.................................................................. (Chinese)
...........................................................................
...................................................
...........................................................................
..................................................................

5. My telephone numbers are .................................... (Home)
................................ (Office)

6. I *+have/have not been convicted in Hong Kong or elsewhere of an offence
punishable with imprisonment. I *have/have not been found guilty in Hong Kong
or elsewhere of unprofessional conduct. I *am/am not the subject of an
existing order under section 22(1)(i) or (ii) of the
Supplementary Medical Professions Ordinance.

I declare that the information given in this application is correct to the
best of my knowledge and belief.

Signed at ..................................................
.............................................. the ................... day of
.................. 19 ...... ｝ (Signature of Applicant)

Before me,

....................................................................
........................................... (Name in block letters)
(Signature)

* Commissioner for Oaths/ Solicitor/Barrister/Part Ia Physiotherapist/
Registered Medical Practitioner.

Photograph of Applicant

+ Please supply details of conviction.

* Delete if inappropriate.

(47 of 1997 s. 10)

FORM 2A [section 9(1)]

PHYSIOTHERAPISTS BOARD

HONG KONG

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

Certificate of Registration

Number of Register : .......................

This is to certify that
...........................................................................
........................... whose photograph appears hereon was on the
.......................... day of .................................... 19
........... admitted to Part Ia of the Register of Physiotherapists.

Dated this ................. day of .......................... 19 ........

Photograph

............................................... Secretary, Physiotherapists
Board. (L.N. 89 of 2004)

FORM 2B [section 9(1)]

PHYSIOTHERAPISTS BOARD

HONG KONG

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

Certificate of Registration

Number of Register : .......................

This is to certify that
...........................................................................
........................... whose photograph appears hereon was on the
.......................... day of .................................... 19
........... admitted to Part Ib of the Register of Physiotherapists.

Dated this ................. day of ....................... 19 ........

Photograph

............................................... Secretary, Physiotherapists
Board. (L.N. 89 of 2004)

FORM 2C [section 9(2)]

PHYSIOTHERAPISTS BOARD

HONG KONG

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

Certificate of Provisional Registration

Number of Register : .......................

This is to certify that
...........................................................................
........................... whose photograph appears hereon was on the
.......................... day of .................................... 19
........... admitted to Part II of the Register of Physiotherapists subject to
the under-mentioned conditions.

Conditions imposed pursuant to section 15(3) of the Supplementary Medical 
Professions Ordinance-

Dated this ................. day of ....................... 19 ........

Photograph

............................................... Secretary, Physiotherapists
Board. (L.N. 89 of 2004)

FORM 3 [section 14]

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

PHYSIOTHERAPISTS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION

Particulars of a Company carrying on the Business of Practising Physiotherapy

Presented by
...........................................................................
...................................... (Name of Company) of
...........................................................................
.............................................................. (Registered
Business Address)
...........................................................................
.................................................................. (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).

or

(If the charge or allegation is that an applicant for registration has been
convicted in Hong Kong or elsewhere of any offence punishable with
imprisonment, has been guilty of unprofessional conduct, is not qualified to
be registered in his application for registration, has been guilty of fraud or
misrepresentation or has failed to comply with the Ordinance) That on the
................... day of .................. 19 ....... you made application
to the Secretary for registration in accordance with section 13 of the
Supplementary Medical Professions Ordinance, whereas
...........................................................................
..................................................................
...........................................................................
...................................................... (set out briefly the
facts alleged); and that in relation to the facts alleged your name should not
be approved to be entered upon the register.

(Where there is more than one charge or allegation they are to be numbered
consecutively).

Notice is further given to you that on ............... (day of the week) the
....................... day of ................... 19 ....., a meeting of the
Board will be held at ..................................................
...........................................................................
................................................................ , at
................. a.m./p.m. to consider the above-mentioned
charge(s)/allegation(s) in a complaint against you, and to determine whether
or not the Board should take any action against you under section
..................................... (state whether section 13 or 22) of the
Supplementary Medical Professions Ordinance.

You are hereby invited to answer in writing the above-mentioned
charge(s)/allegation(s) and also to appear before the Board at the place and
time specified above, for the purpose of answering such
charge(s)/allegation(s). You may appear in person or by counsel or solicitor.
The Board has power, if you do not appear, to hear and decide upon the said
charge(s)/allegation(s) in your absence.

Any answer, admission, or other statement or communication which you may
desire to make with respect to the said charge(s)/allegation(s) in a complaint
should be addressed to the Secretary.

If you desire to make any application that the inquiry should be postponed,
you should send an application in writing to the Secretary as soon as may be,
stating the grounds on which you desire a postponement. Any such application
will be considered by the Chairman of the Board.

A copy of the Physiotherapists (Registration and Disciplinary Procedure) 
Regulation is sent herewith for your information.

.................................................. Secretary, Physiotherapists
Board.

FORM 5 [section 42(2)]

SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359)

PHYSIOTHERAPISTS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION

Summons to Witness

In the matter of a Disciplinary Inquiry under section 13/section 22 of the
Ordinance :

And in the matter of(1)
...........................................................................
......................... To(2)
...........................................................................
...........................................................

You are hereby summoned to appear before the Physiotherapists Board at
.......................
...........................................................................
................ on the ....................................... day of
..................................................... 19 ....................,
at ........................... o'clock in the ...............................
noon to give evidence touching the matter under inquiry(3) and also to bring
with you and produce(4)
...........................................................................
................................
...........................................................................
..................................................................

Given under my hand this ............................... day of
................................... 19 ............

.................................................. Chairman, Physiotherapists
Board.

Note : (1) Insert name of registered physiotherapist.

(2) Insert name and address of witness.

(3) Delete if not required.

(4) Specify the books, documents or other things to be produced. (Enacted
1996)