ANNEXURE

FORM MHCA 33

DEPARTMENT OF HEALTH

UNCONDITIONAL DISCHARGE BY HEAD OF HEALTH ESTABLISHMENT OF STATE PATIENT PREVIOUSLY DISCHARGED CONDTIONALLY

(Section 48(4)(a) of the Act)

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

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

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

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

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

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

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

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

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

I hereby state that the period of the above state patient's conditional discharge has expired, that he / she has complied with the terms and conditions applicable to his / her mental health status and that his / her mental health status and that his / her mental health status has not deteriorated.

The above state patient is hereby unconditionally discharged.

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

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

                    (head of health establishment)

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

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

(Copy to be forwarded to the state patient, registrar of the court concerned, the official curator ad litem and national department)