Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008)

Regulations

Regulations for Prevention of and Treatment for Substance Abuse, 2013

Annexures

Annexure F : Forms

Form 7B : Application on behalf of another person

Purchase

FORM 7B

APPLICATION ON BEHALF OF ANOTHER PERSON

SECTION 32(1)(b) OF THE PREVENTION OF AND TREATMENT FOR SUBSTANCE ABUSE ACT, 2008 (ACT NO. 70 OF 2008)

(Regulation 48)

ADMISSION TO TREATMENT CENTRE

I, ___________________________________________________________________ names),

Identity number: residing at

_______________________________________________________________________________

hereby give consent to be admitted to treatment centre/mentioned below and also appoint:

to facilitate the admission on my behalf—

(a)	________________________________________________________________________

(name of the treatment centre)

(b)	________________________________________________________________________

________________________________________________________________________

(physical address of the treatment centre)

________________________________________________________________________

Signature of person acting on behalf of service user

SIGNED BEFORE ME after I have explained to the said parent or person acting on behalf of service user as set out in section 32(1) of the Act, and have informed *him/her that—

(i)	*he/she may withdraw this consent in writing before a centre manager of the treatment centre at any time during a period of up to 60 days after having given this consent;

PLACE: ________________________________________________

DATE: _________________________________________________