All health establishments and users that are required by the Office to provide information relating to norms and standards, in terms of section 79(2)(b) of the National Health Act, 2003 (Act No. 61 of 2003), must do so by 31 March of each year. If the person in charge, referred to in regulation 6(1), fails to provide the Office with the required information within the specified period, the Office must refer the matter to the head of the national or relevant provincial department of health or the department of a municipality or the head of the health establishment, as the case may be, for intervention in accordance with the intervention policy and procedure of the relevant authority.

Name of health establishment

Legal status

Details of relevant authority (head of national, provincial or municipal health department, head of the health establishment or private hospital group)

Physical address of health establishment

GPS coordinates - latitude and longitude

Contact details of the Health Establishment including—

telephone no.

e-mail address

website details

Name of the person in charge

Contact details of the person in charge

Category of health establishment (according to Policy on Management of Public Hospitals published in Government Gazette No. 34522 of 12 August 2011);

Health district in which the health establishment falls

Services offered by speciality, including number of beds by service or number of consulting rooms

Operating days and times:

In patient unit

Outpatient unit

Emergency unit

Pharmacy

Human resources. Number of staff by category:

Health care professionals

Management

Administrative

Clinical support services

Results of the most recent self-assessment against norms and standards

Chief Executive Office

(signature)

Date