Mental Health Care Act, 2002 (Act No. 17 of 2002)

Regulations

Purchase

ANNEXURE

FORM MHCA 32

DEPARTMENT OF HEALTH

SIX-MONTHLY REPORT ON CONDITIONALLY DISCHARGED STATE PATIENT

(Section 48(3) of the Act)

Surname of state patient............................................................................................

First name(s) of state patient ....................................................................................

File No. (if known) ...............................................

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

Gender:

Male

Female

Occupation

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

Marital status:

Address: ...................................................................................................

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

Nature of charge: .......................................................................................................

Date of conditional discharge: .............................

Date of last report: ..............................

Comment on the extent to which the state patient is adhering to the terms and conditions of the discharge:

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

Current mental health status of state patient:

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

Recommendation to head of health establishment from where the state patient was conditionally discharged

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

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

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

(person monitoring the state patient)

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

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

(Copies to be forwarded to the state patient, head of relevant health establishment, clerk of the court and head of national department)