Regulations > Regulations relating to Child Justice > Annexure > Form 4 : Age estimation of child by medical practitioner

Form 4

AGE ESTIMATION OF CHILD BY MEDICAL PRACTITIONER

SECTION 14 OF THE CHILD JUSTICE ACT, 2008 (ACT NO. 75 OF 2008)

REGULATIONS RELATING TO CHILD JUSTICE

[Regulation 15]

At the Preliminary Inquiry/

In the Child Justice Court held at

Case no/File no.

PART A

Personal particulars of child

Full names and surname
Sex

Particulars of parent, appropriate person or guardian or Child and Youth Care Centre

Full names and Surname / Name of Centre

Contact details of person / Centre

Physical address of person / Centre

PART B

REFERRAL OF CHILD TO MEDICAL PRACTITIONER

TO: Particulars of medical practitioner

Full names and Surname
Particulars of hospital or practice
Contact details
Contact details
Since there is uncertainty as to the age of the child mentioned above, the child is referred to you in terms of section 14(2)(d) of the Child Justice Act, 2008 for an estimation of age. ...................................................................... Signature: Presiding Officer Date:

PART C

MEDICAL ASSESSMENT OF CHILD

Height
Weight
Condition of:	Face
	Lungs
	Heart
	Teeth
	Sight
	Hearing
	Speech
	Bone structure
	Neurological state
	Intellect
Any diseases, infection, injuries or impairment (Indicate degree)
Nutrition	Adequate/deficient. If deficient, provide details
Vaccinations	Yes/No If yes, provide details
Physical development	Normal/abnormal. If abnormal, provide details
Sexual organs	Breasts
	Pubic hair
	Genitals
	Auxiliary
Substance abuse	Yes/No If yes, provide details
Other Observations	Provide details
Medical or other treatment required/ recommended

Remarks

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

Opinion/conclusion

Based on the above-examination and the child's general appearance—
(a)	The age of the child is assessed at being between .................... and ............. , the most probable age is ..............
(b)	The possible date of birth could be ...............................................................

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

Signature: Medical Practitioner

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

Date	Official Stamp

Child Justice Act, 2008 (Act No. 75 of 2008)