ANNEXURE

FORM MHCA 18

DEPARTMENT OF HEALTH

SUMMONS TO APPEAR BEFORE A REVIEW BOARD

(Section 11(2), 29(2)(a) or 35(2)(c) of the Act)

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(name of person summoned and his or her address)

is hereby summoned to appear at .....................................................(place)

on .............................. (date and time) before the Review Board of

..........................................................................(name of health establishment)

to give evidence in respect of ..................................................................................

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(if the person summonsed is to produce any book, record, document or any other item(s))and you are hereby directed to produce:

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(specify the book, record, document or any other item(s) concerned)

Given under the hand of the Chairperson of the Review Board, this ..............................day of .........................................................

Signature: ..........................................................

(Chairperson of Review Board)