Bt€11
REPUALICOF SOUTHAFRICA
DEPARTMENT OF HOME AFFAIRS
MEDICAL CERT!FICATE
COND]TIONS
OF A RECURRENT
i
NATURE
]
po6on(.)
mly bo gcn l.lly In ! good dato ol hollth at tho dmo ol ths rxlmlnadon, lt would i
i Although lh.
bc
.ppt
cl.tod
lf
tho
m.dlc.l
otflcc/pr.cllllonor could turnlrh d.t!ll. of any dl.oa.e, condl$on or dotoct i
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i-'l].ljl:l-9T:*l-:-:-Y-.T:.:-::::9li.Tll:--.-.-...---.--- ....I herebyc6nifythal I havooxaminedthe followingp€rson(s):
1.
7.
8.
and find him/h6r^h9rn(l) nol rlo ally dliordctld, or physlc. y d€focilvo In any w!y;
(b) not.uftrrlng lrom loproly, von.ral dl!ca!o, tr.chon!, or othsr Inf€c$on3 or contagloug
condltlon;
(c) g.ncrally In a good dato of herlth;
excoptfor lho followingdetectsobservedl
(Ple.se typo or pftnt)
Deta(srcgading he dijortur, dis€ssao, disabitity,the soiousrtsssthe6ol and
. the treatnent,il any,prcscdbed/rccgmnended
Name ol pe6on(s)
Offcial 6tampand a&rcse of medktalolfce
pac.tft4onehospibl
Signaturcol medicdlofticerhrcctitioner
Date
Ini. cotL
290-290 All psycho8€!.
301
r "it.ni.tty dt.ordond" lnctu.b. rh€ tolowtng:
Penson.liiydisoders,
308
B€haviourdlstrnbanc€sot chttdhood.
310-315 Allloms ol m€ntalrotardarton.
3?0-.?48 Epir€psyand all oth€rioms ot degen€ialtonol th6 contratn€rvoussyst€m.
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