Mental Health Care Act, 2002 (Act No. 17 of 2002)RegulationsGeneral RegulationsAnnexuresForm MHCA 28 |
ANNEXURE
FORM MHCA 28
DEPARTMENT OF HEALTH
CANCELLATION OF LEAVE OF ABSENCE OF A STATE PATIENT OR AN ASSISTED OR INVOLUNTARY MENTAL HEALTH CARE USER
(Sections 45(3), 66(1)(j) of the Act)
I hereby cancel the leave of absence of .............................................................
(name of state patient, assisted or involuntary mental health care user)
File No. ................................
You are not complying with the terms and conditions applicable to the leave of absence and/or have/has relapsed to the extent of requiring hospitalization.
Reasons for cancellation of leave of absence:
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You must return to ..........................................................................................
(name of detention centre)
by ............................................................................... (date) or you will be reported to the South African Police Services as absconded.
Print initials and surname: .........................................
Signature: ......................................................................
(head of health establishment)
Date: .......................................
Place: .............................................
(Copy to custodian)