Statistics Act, 1999
R 385
Mental Health Care Act, 2002 (Act No. 17 of 2002)RegulationsGeneral RegulationsAnnexuresForm MHCA 20 |
ANNEXURE
FORM MHCA 20
DEPARTMENT OF HEALTH
ORDER BY REVIEW BOARD TO TRANSFER MENTAL HEALTH CAREUSER / STATEPATIENT / MENTALLY ILL PRISONER
| (a) | an assisted or involuntary mental care user in terms of section 39(4) of the Act to maximum security faciltities; |
| (b) | a State patient between designated health establishments in terms of section 43(3) of this Act; or |
| (c) | a mentally ill prisoner between designated health establishments in terms of section 54(2) of the Act. |
Surname of mental health care user / state patient / mentally ill prisoner ........................................................
First name(s) of mental health care user / state patient / mentally ill prisoner ..................................................
Date of birth ................................................or estimated age ....................
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Gender:
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Male |
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Female |
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Occupation ..................................................................................................... |
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Marital status: |
S |
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M |
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D |
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W |
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Health establishment making the request: ......................................................................
The Review Board of .......................................................................................................
(name of Review Board)
has considered documentation and representation relevant to the transfer of the above User to a maximum security facility.
The Review Board has considered inter alia whether —
| (a) | the transfer is not being done in order to punish the User. |
| (b) | the transfer is warranted taking cognizance of the mental health status of the User. |
Reason(s) for transfer:
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The above mental health care user / state patient / mentally ill prisoner must be transferred to a health establishment with maximum security facilities.
Print initials and surname: ....................................................................
Signature: .............................................................................................
(Chairperson of Review Board)
Date: ...............................................
Place: ........................................................
[Copy to:
With respect to assisted- and involuntary mental health care Users, this order must be sent to the head of the provincial department and the Head of health establishment.
With respect to state patients and mentally ill prisoners the order must be sent to the head of the national department]
