Forms - Townhill Hospital

• MHCA 1 : Emergency admission or treatment without consent Example
• MHCA 2 : Report on exploitation, physical or other abuse, neglect or degrading treatment of a mental health care user
• MHCA 4 : Application for assisted or involuntary care, treatment and rehabilitation Example 1 |  Example 2 (application by Health Care Provider)
• MHCA 5 : Examination and findings of mental health care practitioner following and application for assisted or involuntary care, treatment and rehabilitation Example 1  completed by medical practitioner  | Example 2 completed by Professional nurse
• MHCA 6 : 72-hour assessment and findings of medical practitioner or mental health care practitioner after head of health establishment has granted application for involuntary care, treatment and rehabilitation Example
• MHCA 7 : Notice by head of health establishment on whether to provide assisted or involuntary inpatient care, treatment and rehabilitation
• MHCA 8 : Notice by head of Health Establishment to review board requesting approval for further involuntary care, treatment and rehabilitation on an inpatient basis Example
• MHCA 9 : Notice by Head of Health Establishment after 72-hour assessment period informing review board that mental health care user warrants further involuntary care, treatment and rehabilitation on an outpatient basis Example
• MHCA 10 : Transfer of involuntary mental health care user - schedule of conditions relating to his or her outpatient care, treatment and rehabilitation Example
• MHCA 11: Transfer of involuntary mental health care user on inpatient basis to psychiatric hospita1 Example
• MHCA 12 : Transfer of involuntary mental health care user from inpatient to outpatient and vice versa Example
• MHCA 22: Handing over custody by the South Africa police services of a person suspected of being mentally ill or severely or profoundly intellectually disabled and likely to inflict serious harm  Example
• In-patient referral form to psychiatric institution
• Suicide risk assessment form

• Enquiry form to the Townhill Hospital Adolescent Unit - Sinothando

• Referral form to psychiatric OPD clinic

• Referral criteria for Townhill hospital

• Psychiatric services : Area

Referral Forms

• Referral form to psychiatric OPD clinic (for Medical Practitioners) *
• Referral form to Psychiatric OPD clinic (for Allied health professionals)
• Psychiatric community service referral form
• Referral fax to Townhill hospital
• Referral to North Park Ward - Townhill hospital

* Forms can be completed electronically

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