National Health Act, 2003 (Act No. 61 of 2003)

Regulations

Procedural Regulations Pertaining to the Functioning of the Office of Health Standards Compliance and Handling of Complaints by the Ombud

Annexure

Prescribed Forms

OHSC 5 : Application for renewal and extension of certification

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OHSC 5

 

APPLICATION FOR RENEWAL AND EXTENSION OF CERTIFICATION

In terms of section 82(7) of the National Health Act, 2003 (Act No. 61 of 2003) as read together with regulation 19 of the Procedural Regulations pertaining to the Functioning of the Office of Health Standards Compliance and Handling of Complaints by the Ombud (the Regulations), an application for renewal of a certificate must be submitted to the Office, within a period of not more than six months before the expiration of the certificate of compliance. This certificate will be renewed following an inspection as set out in regulation 14, provided that the Office may extend the certification for up to 1 year pending an inspection.

 

Name of health establishment applying for extension of certification

 


Address

 


Name of person in charge

 


Date of last inspection

 


Date of certification

 


Date of expiry of certification

 


Certificate number

 


Person in charge of health establishment

 

 

(Signature)

Date

 

                                                       

 

 

Attachments:

 

1.Most recent report submitted
2.Last 6 months of reporting on indicators of risk
3.Annual self-assessment reports since last inspection
4.Most recent quality improvement plan