Mental Health Care Act, 2002 (Act No. 17 of 2002) Regulations General Regulations Annexures Form MHCA 26

 

ANNEXURE

FORM MHCA 26

 

DEPARTMENT OF HEALTH

 

NOTICE OF THE RETURN OF AN ABSCONDED ASSISTED USER / INVOLUNTARY USER / STATE PATIENT / MENTALLY ILL PRISONER

(Sections 40(4) or 57(1) of the Act)

(to be completed by the head of Health Establishment)

 

 

Surname of assisted user / involuntary user / state patient / mentally ill prisoner  .....................................................

 

First name(s) of assisted user / involuntary user / state patient / mentally ill prisoner  ...............................................

 

Date of birth  .............................or estimated age ....................

 

 

 

 

Date if admission to health establishment: ..............................................................

 

The above assisted user / involuntary user / state patient / mentally ill prisoner absconded from : .....................................(name of health establishment)

 

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

 

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

 

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

 

Date of abscondment: ..............................................................................................

 

Date of return: .........................................................................................................

 

Returned by (e.g. SAPS, self, relative):

 

 

Print Initials and Surname: .......................................................................................

 

Force Number if applicable: .....................................................................................

 

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

 

State physical / mental condition:

 

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

 

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

 

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

 

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

 

 

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

                                                         (head of health establishment)

 

 

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

 

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

 

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

 

 

[In case of an assisted or involuntary mental health care user: copy of this notice to be submitted to the Review Board and head of provincial department]

[In case of state patient: copy of this notice to be submitted to Registrar or Clerk of the relevant Court, official curator ad litem and head of national department]

[In case of a mentally ill prisoner: copy of this notice to be submitted to the Magistrate,

head of the prison from where the User was initially transferred and to head of national department]