ANNEXURE

FORM MHCA 23

DEPARTMENT OF HEALTH

TRANSFER OF STATE PATIENTS FROM DETENTION CENTRE TO A DESIGNATED HEALTH ESTABLISHMENT

(Sections 42(3) of the Act)

OR

TRANSFER OF MENTALLY ILL PRISONERS FROM PRISON TO DESIGNATED HEALTH ESTABLISHMENT

(Section 53(2) of the Act)

Surname of state patient / mentally ill prisoner  .....................................................

First name(s) of state patient / mentally ill prisoner  ................................................

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

Residential address:

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

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

The above state patient, currently held in detention at ...................................................(name of detention centre) must be transferred to

................................................(name of health establishment) for care, treatment and rehabilitation services.

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

                   (Head of  national department)

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

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

[Copy to be forwarded to head of detention centre and the official curator ad litem]

[On receipt of a court order in terms of section 42(1) of the Act, Form J105, the national department must complete MHCA 23 and forward a copy to the detention centre and head of health establishment concerned]