ANNEXURE

FORM MHCA 07

DEPARTMENT OF HEALTH

NOTICE BY HEAD OF HEALTH ESTABLISHMENT ON HIS/HER DECISION WHETHER TO PROVIDE ASSISTED OR INVOLUNTARY IN-PATIENT CARE,

TREATMENT AND REHABILITATION

(Section 27(9), 28(1), 33(7) or 33(8) of the Act)

Section 1

I ............................................................................................................................(name of head of health establishment) hereby:

of .........................................................................................(name of User).

Section 2

Whereas the findings of the medical practitioner and another mental health care practitioner concur that the User—

The reasons for consenting are as follows:

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

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

Signature: ........................................................... (head of health establishment)

Date: ................... (Time) ...................

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

[Copy to Applicant and original to the Review Board]