Before revoking a certificate of compliance or imposing a fine in terms of section 82A(4) of the National Health Act, 2003 (Act No. 61 of 2003), ("the Act"), the Office must, in terms of regulation 25 of the Procedural Regulations pertaining to the Functioning of the Office of Health Standards Compliance and Handling of Complaints by the Ombud ("the Regulations") notify a health establishment of its intention to revoke the certificate of compliance or to impose a fine, as the case may be, and initiate a hearing to allow the health establishment an opportunity to make representations, before a final decision is taken.

Name of health establishment

Address of health establishment

Name of person in charge

Contact information of person in charge

Name of relevant authority

Contact information for relevant authority

Date, time and place of hearing

Name and position of presiding officer

Subject matter of hearing

Required documents, records, objects or materials

Date for submission of above

Annexures: