ANNEXURE

FORM MHCA 37

DEPARTMENT OF HEALTH

MAGISTERIAL ORDER TO HEAD OF PRISON TO—

(a) TRANSFER PRISONER TO HEALTH ESTABLISHMENT; OR

(b) TAKE NECESSARY STEPS TO ENSURE THAT THE REQUIRED LEVELS OF CARE AND TREATMENT ARE PROVIDED TO THE PRISONER CONCERNED

(Section 52(3)(a) or (b) of the Act)

Surname of the prisoner: ........................................................................................

First name(s) of the prisoner:  ..................................................................................

Date of birth:  ............................................or estimated age ....................

Residential Address: ..................................................................................................

..................................................................................................................................

..................................................................................................................................

Prison number: .........................................................

Charge against prisoner: ............................................................................................

I hereby order that due to mental illness / intellectual disability the above User be transferred to a designated health establishment for care, treatment and rehabilitation in accordance with the procedure in section 54 of the Act.

Note: attach copy of MHCA 36 as completed by person who assessed the mental health care status of the prisoner concerned.

OR

I hereby order that the above User be provided with the required levels of care within the prison / prison hospital *

Print initials and surname: ............................................

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

                     (magistrate)

Date: ...................................

Place: ...................................................

[Copy to be forwarded to the Review Board Curator / Administrator (if appointed) and the head of the national department]