Mental Health Care Act, 2002 (Act No. 17 of 2002)

ANNEXURE

FORM MHCA 11

DEPARTMENT OF HEALTH

TRANSFER OF ASSISTED / INVOLUNTARY MENTAL HEALTH CARE USER ON INPATIENT BASIS TO ANOTHER HEALTH ESTABLISHMENT

(Section 27(10) and 34(4), of the Act)

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

(name and surname of mental health care user)

on an inpatient basis who was admitted to ...................................................................................(name of health establishment)

on ...........................................(date) must be transferred to .......................................................(name of health establishment)

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

(head of health establishment)

Signature: .............................................................................................

(Head of health establishment)

Date: ...............................

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

[Copy to Review Board]