Mental Health Care Act, 2002 (Act No. 17 of 2002) Regulations General Regulations Annexures Form MHCA 37

 

ANNEXURE

FORM MHCA 37

 

DEPARTMENT OF HEALTH

 

MAGISTERIAL ORDER TO HEAD OF PRISON TO—

(a) TRANSFER PRISONER TO HEALTH ESTABLISHMENT; OR

(b) TAKE NECESSARY STEPS TO ENSURE THAT THE REQUIRED LEVELS OF CARE AND TREATMENT ARE PROVIDED TO THE PRISONER CONCERNED

(Section 52(3)(a) or (b) of the Act)

 

 

Surname of the prisoner: ........................................................................................

 

First name(s) of the prisoner:  ..................................................................................

 

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

 

 

 

 

Residential Address: ..................................................................................................

 

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

 

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

 

Prison number: .........................................................

 

Charge against prisoner: ............................................................................................

 

I hereby order that due to mental illness / intellectual disability the above User be transferred to a designated health establishment for care, treatment and rehabilitation in accordance with the procedure in section 54 of the Act.

 

Note: attach copy of MHCA 36 as completed by person who assessed the mental health care status of the prisoner concerned.

 

OR

 

I hereby order that the above User be provided with the required levels of care within the prison / prison hospital *

 

 

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

 

 

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

                     (magistrate)

 

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

 

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

 

[Copy to be forwarded to the Review Board Curator / Administrator (if appointed) and the head of the national department]