Regulations > General Regulations > Annexures 1-46

ANNEXURE

FORM MHCA 32

DEPARTMENT OF HEALTH

SIX-MONTHLY REPORT ON CONDITIONALLY DISCHARGED STATE PATIENT

(Section 48(3) of the Act)

Surname of state patient............................................................................................

First name(s) of state patient ....................................................................................

File No. (if known) ...............................................

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

Gender:

Male

Female

Occupation

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

Marital status:

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

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

Nature of charge: .......................................................................................................

Date of conditional discharge: .............................

Date of last report: ..............................

Comment on the extent to which the state patient is adhering to the terms and conditions of the discharge:

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

Current mental health status of state patient:

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

Recommendation to head of health establishment from where the state patient was conditionally discharged

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

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

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

(person monitoring the state patient)

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

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

(Copies to be forwarded to the state patient, head of relevant health establishment, clerk of the court and head of national department)

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