Regulations > Criminal Law (Sexual Offences and Related Matters) Regulations > Annexures > Annexure A : Forms: Services for victims of sexual offences and compulsory HIV testing of alleged sex offenders > Part I of Regulations: Services for Victims of Sexual Offences and Compulsory HIV Testing of Alleged Offenders > Form 7 : Recording of HIV tests results obtained in terms of an order by magistrate

FORM 7

[Regulation 8(1)]

RECORDING OF HIV TEST RESULTS OBTAINED IN TERMS OF AN ORDER BY MAGISTRATE

Section 33(1)(d)(ii) of the Criminal Law (Sexual Offences and Related Matters) Amendment Act, 2007 (Act No. 32 of 2007) (the Act)

(To be completed by the head of a public health establishment designated in terms of section 29 of the Act or by a person designated in writing by the head of such establishment)

Name of Health Facility: .....................................................

OFFICIAL STAMP OF HEALTH ESTABLISHMENT

Case No: ...................................................................................................................................

Date test performed: ..................................................................................................... 20......

PART A: PARTICULARS OF ALLEGED OFFENDER

Full names: ...............................................................................................................................

Date of birth:. ...........................................................................................................................

Age: ..........................................................................................................................................

Identity number/passport number: ...........................................................................................

Home address/temporary address: ...........................................................................................

PART B: PARTICULARS OF HIV TESTS PERFORMED

Type of HIV tests performed: .......................................................................................................

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

PART C: RESULTS OF HIV TESTS

(Mark relevant block with a cross)

Positive ¨

Negative ¨

Remarks: .....................................................................................................................................

PART D: PARTICULARS OF DESIGNATED HEALTH ESTABLISHMENT PERFORMING HIV TESTS AND WHERE EXTRA TEST RESULT WILL BE KEPT:

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

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

Telephone No: ...........................................................................................................................

Name of person who performed the tests: .................................................................................

Signature of person who performed the tests: ............................................................................