Mental Health Care Act, 2002 (Act No. 17 of 2002) Regulations General Regulations Annexures Form MHCA 38

 

ANNEXURE

FORM MHCA 38

 

DEPARTMENT OF HEALTH

 

APPLICATION TO MAGISTRATE FOR CONTINUED DETENTION OF A MENTALLY ILL PRISONER

(Section 58(3) of the Act)

 

 

Surname of mentally ill prisoner: ..................................................................................

 

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

 

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

 

 

 

 

Health establishment concerned: ...................................................................................

 

File No: ...........................................................................................................................

 

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

 

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

 

The above mentally ill prisoner has been admitted at:

 

...........................................................................................................(name of health establishment)

 

as a mentally ill prisoner since:  ..........................................................(date of admission)

 

The date of expiry of his / her prison sentence is: ..................................................... (date of expiry of sentence)

 

Application for further confinement of the User in terms of Chapter V of this Act was made on ........................................... by ................................................................

 

In terms of section 58(3) of the Act, I hereby request permission to keep this User at this health establishment and provided care, treatment and rehabilitation pending the outcome of the application.

 

 

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

 

 

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

                     (head of health establishment)

 

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

 

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