Mental Health Care Act, 2002 (Act No. 17 of 2002)RegulationsGeneral RegulationsAnnexuresForm MHCA 14 |
ANNEXURE
FORM MHCA 14
DEPARTMENT OF HEALTH
DECISION BY REVIEW BOARD CONCERNED—
| (a) | assisted mental care, treatment and rehabilitation [section 28(3) of the Act]; |
| (b) | appeal against decision of head of health establishment concerning assisted care, treatment and rehabilitation [section 29(2) of the Act]; |
| (c) | further involuntary care, treatment and rehabilitation on an inpatient basis [section 34(7) of the Act]; or |
| (d) | appeal against decision of head of health establishment on involuntary care, treatment and rehabilitation [section 35(2) of the Act] |
Gender:
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Male |
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Female |
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Occupation ..................................................................................................... |
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Marital status: |
S |
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M |
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D |
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W |
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Residential address:
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The Review Board of .....................................................................................
(name of review Board)
have considered documentation and issues relevant to:
Application for assisted/involuntary care, treatment and rehabilitation of the above User:
The Review Board have considered (inter alia) whether:
| (a) | the User is capable of making an informed decision on the need to receive care, treatment and rehabilitation services. |
| (b) | the User is suffering from a mental illness or severe or profound intellectual disability, and as a consequence of this requires care, treatment and rehabilitation for his / her health and safety or the health and safety of others. |
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unwilling |
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to receive care, treatment and rehabilitation services. |
| (d) | the User is likely to inflict serious harm on him / herself or others. |
| (e) | care, treatment and rehabilitation is necessary for the User's financial interest and reputation. |
| (f) | the User's right to movement, privacy and dignity will be unnecessarily restricted. |
Application to appeal against decision of head of health establishment on assisted
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/ involuntary |
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care, treatment and rehabilitation |
The Review Board has requested / provided the opportunity for the following to make oral or written representations on the merits of the request:
(a) Applicant
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(b) Appellant
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(c) Independent mental health care practitioner(s)
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(d) Head of health establishment
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(e) Others
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The Review Board has considered the appeal in the prescribed procedure and has decided that—
(a) the User should be discharged from the health establishment
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outpatient |
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Reasons for this decision:
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Print initials and surname: ....................................................................
Signature: .............................................................................................
(Chairperson of Review Board)
Date: ....................................
Place: ..........................................
[Copy to be sent (as applicable) to: applicant, appellant, head of health establishment concerned, head of provincial department and High Court Judge]